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LIBRARY OF CONGRESS. 

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UNITED STATES OF AMERICA. 






FRIEND IN NEED: 



HOUSEHOLD GUIDE IN HEALTH AND 
IN DISEASE. 



BY 



DOCTOR frank; 



AUTHOR OF " HEALTH IN OUR HOMES," "HEALTH OF OUR 
CHILDREN," ETC. 



JR \ 



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BOSTON: 
THAYER PUBLISHING COMPANY. 



1887. 



Copyright, 1887, by 
Thayer Publishing Company. 



Electrotyped 
By C. J. Peters and Son, Boston. 



CONTENTS. 



BOOK I. — PRACTICAL HYGIENE. 

CHAPTER I. — FOOD. 

Relation of diet to health. Obligations imposed by nature 1 

Study of the digestive organs 2 

Researches of Dr. Beaumont. Alexis St. Martin 3 

Comparative digestibility of different substances 4 

The process of digestion. Changes in cooking food 5 

The preservative processes. The natural diet of man 7 

Dietetic value of meat. Classification of foods 8 

Influences affecting the flesh of animals. Jewish customs 9 

Meats. Relative amount of bone in animals 10 

Poultry and game. Improved by proper feeding 11 

Fish. Value as food estimated 12 

The duties of the digestive organs defined . . 13 

Nature's generous endowments ...» 13 

The effect of salted meats and fish upon the system 14 

The influences which affect the edible qualities of fish 15 

Shell-fish. Fish-antipathies IS 

Viscera. Foie gras. Fattening geese 19 

Eggs. Digestibility, and value as food 20 

Milk. Different constituents. Preservative processes 21 

Infant-feeding. Advice to mothers 24 

Butter. Oily matters require no digestion 25 

Cheese. Different varieties. Dietetic value 26 

Wheat. Bread. Injurious effects of alum ........ 28 

Destructive action of moisture on flour 30 

Barley. Oats. Oatmeal 31 

Rye. Symptoms of ergotism. Indian corn 32 

Rice. Proper method of cooking 33 

Buckwheat. Leguminous seeds. Beans . 34 

Peas. Tubers and roots. Potatoes 35 

Carrots. Parsnips. Used in manufacture of wine 36 

The turnip. Beet-root. Radishes 37 

Herbaceous articles. Sauer-Kraut 3S 

Fruity products. Fungi. Mushrooms 40 

Fruits. Pleasing food. Proper time for eating 41 

Oleaginous seeds. Nutritiousness of cocoa-nut 43 

iii 



IV CONTENTS. 

CHAPTEE II. - ACCESSORY FOODS. 

Foods not essential to health, but a part of man's diet 46 

Alcohol. Improper estimate of its value 47 

Influence of alcohol on different organs of the body 48 

Interesting observations of Dr. Parkes 49 

Desirability of alcohol in health 50 

Influence of alcoholic stimulants in preventing disease 51 

Alcohol in man's unusual experiences 52 

Pernicious result from the use of alcohol in yellow fever 53 

Moderate drinkers the most certain victims to alcohol 54 

Methods of reform advocated to subdue intemperance 55 

Tobacco. Essential properties. Relative amount of nicotine .... 57 

The dangers of cigarette-smoking 58 

Temperate use of tobacco by adults, productive of but little injury ... 60 

Canned goods. Safety. Importance 62 

Instances of poisoning by canned foods 63 

Food-antipathies. Cases illustrating the subject 64 

General remarks on diet . 65 

Gluttony an unpardonable sin 66 

Dr. Tanner's fast of forty days 67 

The proper amount of food. The common error 68 

The underfed a class of no inconsiderable number . . . . . . 70 

The selection of food. Value of meat overestimated 71 

The time for taking food. Regularity a primary essential 72 

The influence of sleep on digestion 74 



CHAPTER III. —PHYSICAL EXERCISE. 

Perfect health defined. The baneful influence of inactivity 75 

Dangers of deficient and immoderate exercise 76 

The effect of great muscular effort on the heart 76 

Intellectual faculties are strengthened by physical exercise 77 

Results of overexertion «8 

The power of the heart to resist disease when overtaxed 79 

Some of the consequences of exhaustion 80 

The amount of exercise to be taken 80 

The hardest day's work noted by Dr. Parkes 80 

The time for exercise and labor 81 

Rest after eating imperative 81 

Advice to literary men 82 



CHAPTER IV. —SLEEP. 

Rest and exercise alike essential to health 83 

Regularity in the hour of retiring important 84 

The advantages of early rising 85 

Dr. Abernethy's hygienic advice 86 

The disorders which are benefited by early rising 86 

The amount of sleep required S7 

The sleeping-room and furnishings 88 



CONTENTS. V 

Sanitary precautions of the greatest importance . 88 

Feather-beds absolutely forbidden. Bed-clothing. Ventilation . . . 89 

Separate beds a rigid law of health 00 

CHAPTER V. — BATHING. 

The functions of the skin denned 91 

Toilet-bath. Disorder of the sweat-glands 92 

Treatment for excessive sweating, local and general 93 

Selection of soaps. General bathing 04 

When the cold bath should be indulged 95 

Exercising freely before cold bathing judicious 96 

Warm bath. Hot bath a powerful stimulant 97 

Shower-bath. Sitz-bath. Vapor-bath 98 

Sea-bathing, its merits and its dangers 99 

Precautions to be observed in bathing 100 

CHAPTER VI. — CLOTHING. 

Comparative value of different fabrics 101 

Only fools and beggars suffer from cold 102 

The proper arrangement of woman's clothing 103 

Dress-reform and improvements advocated 103 

Corsets. Tight lacing. Braces system of suspension 104 

Comments on woman's fashions 105 

Reform in the clothing of men advocated 105 

General rules on the subject of clothing 106 

Washing woollen fabrics. Poisonous dyes 107 

CHAPTER VII. —CARE OF THE MOUTH. 

Habits born of thoughtlessness and vulgarity . . 108 

Indiscriminate kissing and its dangers 108 

Teething. Delusions. Convulsions in children 109 

The teeth indicative of the innate constitution 109 

Duties of parents. Tooth-powders. Mouth-wash . . . . . . .110 

Agents which are injurious to the teeth Ill 

Decay prevented by cleanliness Ill 

CHAPTER VIII. —CARE OF THE HAIR. 

General management. Affections of the oil-glands 112 

Champoos. Drying the hair. Bangs and crimping 113 

Alopecia. Dandruff. Course of the disease 114 

Treatment of seborrhcea, or dandruff 115 

Premature baldness. Alopecia furfuracea . .116 

Neglect a cause of scalp disorders 117 

Barbers. Sea-foam champoo. Hair-tonics US 

Poisonous absorption from hair-dyes HO 

CHAPTER IX. —CARE OF THE HANDS. 

Diseases of the skin. Excessive sweating 120 

Cleaning and cutting the nails 1-0 



VI 



CONTENTS. 



Prevention and treatment of ingrowing nails 121 

Felons. Progress and dangers. Treatment 122 

Death of the bono not uncommon 122 

Liability of the patient 123 

and how removed 123 

CHAPTER X.— CARE OF THE FEET. 

The structure of the foot, A marvel of ingenuity 124 

Fitting of shoes. Height of heels 124 

Painful affections. Materials for foot-coverings 125 

Form of shoes. Boots. Stockings 125 

Treatment for excessive perspiration. Cold feet 126 

Rubbers. Overshoes. Cloth gaiters 126 

Necessity of keeping the feet warm 127 



BOOK IL — MENTAL HYGIENE. 

INTELLECTUAL OPERATIONS. 

Relation of instinct and reason . 128 

The decree to labor a wise dispensation 129 

Mental exhaustion. Professions which induce insanity 130 

Inordinate exercise of the intellect. Pleasurable passions 131 

Painful passions, and their physical influences 132 

Anger and fear. Habitual irritability 133 

Mental relation of woman to man 134 

Consequences of excessive fright 135 

Influence of religion when perverted 136 

Grief and despondency. Death from shock 137 

Anxiety. Despair. Envy. Jealousy 138 

Shame. Avarice. Suspicion. Ambition . . 139 

The intimate union between the mind and body 140 



BOOK III. — THE SICK-ROOM. GENERAL MANAGEMENT. 

CHAPTER I. —PRACTICAL HINTS ON NURSING. 



Qualifications of a nurse 

Firmness. Discipline. Gentleness. Serenity . 

Duties of a nurse to the physician 

Training-schools. Rules for the government of relatives 
The sick-room, furnishings, and location .... 
Ventilation and heat. Controlling the supply of air . 

Beds and bed-making 

Moving a patient from one bed to another . 

Led- nptoms. Prevention. Treatment . 

General rules on nursing 



141 

142 
143 
144 
145 
146 
147 
148 
149 
150 



CONTENTS. Vll 

CHAPTER II.— DIETETIC TREATMENT OF THE SICK. 

Importance of feeding the sick 152 

Need of instruction in dietetics 155 

Delusions regarding beef-tea 156 

Invalids' food, and its administration l.> 

The resources in feeding the sick 159 

Digestion of milk facilitated 160 

How to prepare beef-tea and other meat-liquids 100 

Cold-made infusions. Raw eggs. Fortified gruels 161 

Cuisine of the sick-room. Preparation of liquid foods 102 

Liebig's method of preparing infant's food 100 



BOOK IV. — PRINCIPLES OF MEDICINE. 

4 CHAPTER I. — SYMPTOMS OF DISEASE. 
Health and disease defined 108 



Pulse. Respiration. Cough 

Expectoration. Temperature. Fever. Danger-line 

The use of the thermometer. Chills and rigors . 

Attitude of the patient. Expression of the face 

Changes in special senses. Indications offered by the tongue 

Throat-symptoms. Appearance of the skin. Loss of appetite 

Nausea and vomiting. Excremental discharges . 

Changed characteristics of the urine. State of nutrition 

Emaciation. Glandular enlargement. Dropsy . 



109 
170 
171 
172 
173 
174 
175 
176 
177 



CHAPTER II. — CAUSES OF DISEASE. 

Causes as generally defined 178 

Explanation of terms. Infection and contagion 179 

Disease-poisons. Miasm. Causes as distinguished 180 

Diagnosis. General consideration of symptoms 181 

Difficulties in discriminating between diseases. Prognosis 182 

Unfavorable influences and symptoms 183 

Signs of impending death 183 

CHAPTER III.— MEDICINES AND THEIR ADMINISTRATION. 

How medicines are introduced into the system 185 

The forms in which drugs are administered 186 

How to estimate doses for children 187 

Caution in the use of medicines imperative 18S 

The use of opiates. Extreme care necessary 189 

How to avoid mistakes in the sick-room 190 

The family medicine-chest 191 

Variability of drops. Apothecaries' measures. Fluid measures ... 191 

Approximate measures. Enemata. Quantity proportionate to the age . . 192 

Medicines and food by injection 1^3 

Stimulant enemata. Suppositories 194 



\ 111 CONTENTS. 



BOOK V. — THE PRACTICE OF MEDICINE. 

INTRODUCTORY. 

;ts under which individual diseases are considered 195 

Definition of terms. Measures employed 196 

Physical signs which assist in diagnosis 196 

The dose prescribed is in every instance for an adult 197 

The popular treatment of the present time advised 197 



SECTIOX I. — DISEASES OF THE RESPIRATORY SYSTEM. 

CHAPTER I. — ACUTE, CHRONIC, AND SUPPURATIVE PLEURITIS. 

Acute Pleuritis. Structural changes described 198 

Character of the effusion. Symptoms 199 

Mild attacks. Causation 200 

Diagnosis. Physical signs 201 

Prognosis. Duration. Treatment 202 

Chronic pleuritis. Symptoms and course 203 

Causation. Diagnosis and prognosis . . . . . . . . 204 

Treatment of chronic pleuritis 205 

Empyema. Suppurative pleuritis. Symptoms. Causation 205 

Diagnosis. Prognosis. Treatment 206 



CHAPTER II. — PNEUMONITIS, PLEURODYNIA, INTERCOSTAL NEU- 
RALGIA. 

Pneumonitis. Seat of the inflammation. Varieties. Symptoms .... 207 

Division into different stages 208 

Causation. Diagnosis. Physical signs 209 

Prognosis. Unfavorable symptoms. Treatment 210 

Pleurodynia and intercostal neuralgia 211 

Symptoms and diagnosis. Treatment . 211 



CHAPTER III. — CHRONIC AND ACUTE PULMONARY CONSUMPTION. 

Chronic consumption. Structural changes. Symptoms 213 

Co-existing affections 214 

Causation. Germ theory. Diagnosis 215 

Prognosis. Duration. Treatment 216 

Health resorts. Hemorrhage from the lungs . .217 

Acute pulmonary consumption 218 



CHAPTER IV.— ACUTE, CAPILLARY, AND CHRONIC BRONCHITIS. 

Acute bronchitis. Anatomical characters. Symptoms 220 

Causation. A frequent complication. Influenza 221 

Diagnosis. Prognosis. Treatment 222 

Capillary bronchitis. Symptoms 223 



CONTENTS. IX 

Course and treatment 224 

Chronic bronchitis . * 225 

Knife-grinders' or stone-cutters' phthisis 225 

Symptoms, course, and treatment 220 

CHAPTER VI. — ASTHMA. 

Development of asthma. Symptoms 227 

Complications. Causation 228 

Diagnosis. Prognosis 229 

Treatment of attacks 220 

Treatment between paroxysms 230 

Hygienic measures 230 

Constitutional remedies to be employed 231 

CHAPTER VII. — ACUTE CORYZA, CHRONIC NASAL CATARRH. 

Acute coryza. Symptoms and course 232 

Duration and treatment 233 

Chronic nasal catarrh. Exciting causes 233 

Different forms 234 

Symptoms and prognosis 234 

Treatment. Internal medication 235 

Local measures • 236 



SECTION II. — DISEASES OF THE CIRCULATORY SYSTEM. 

CHAPTER I. —DISEASES OF THE HEART. 

Introductory. The circulatory apparatus 238 

Pericarditis. Endocarditis 239 

Valvular diseases of the heart 240 

Functional disorder of the heart 241 

Angina pectoris . 243 

CHAPTER II. —ANAEMIA, CHLOROSIS, PLETHORA. 

Anaemia, or impoverishment of the blood 246 

Symptoms, duration, and prevention 247 

Dietetic and medicinal treatment 248 

Chlorosis. Predisposing causes. Symptoms 249 

Treatment of chlorosis. Plethora 250 

CHAPTER III. — CORPULENCE. 

Prescription of Hippocrates 252 

Consequences of corpulency. Curability 253 

Dietetic and hygienic treatment 254 

Banting's dietary table 255 

Personal experiences of the author .......... 255 

The influence of fatty food 256 



\ CONTENTS. 

SECTION III. — DISEASES OF THE DIGESTIVE SYSTEM. 

CHAPTER I. — DYSENTERY. ENTERITIS. 

Dysentery. Anatomical characters. Symptoms 257 

Causation. Probable contagion . 258 

Prognosis. Treatment 259 

Malignant forms of dysentery 260 

Enteritis. Anatomical characters. Symptoms 261 

Causation. Diagnosis. Prognosis. Treatment 262 

CHAPTER II. — PHARYNGITIS, TONSILLITIS, PAROTITIS. 

Acute and chronic pharyngitis. Prevalence 264 

Symptoms, course, and treatment 265 

Simple and follicular tonsillitis 266 

The presence of a specific poison probable 267 

Treatment. Abscess of the tonsil 268 

Parotitis. General description and treatment 269 



SECTION IV. — DISEASES OF THE STOMACH AND INTES- 
TINES. 

CHAPTER I. — DYSPEPSIA. 

Variable consequences of indigestion 271 

Symptoms. Mental influences 272 

Agencies active in causation 273 

Hygienic and dietetic treatment 274 

Medicinal measures. Bilious symptoms 275 

CHAPTER II. — DIARRHCEA, CONSTIPATION. 

Different forms of diarrhoea 277 

Important rules in treatment 278 

Chronic diarrhoea. Treatment 279 

Constipation. Manifold causes 280 

Constitutional character. Management 281 

Medicinal remedies to be employed 282 

CHAPTER III. —COLIC, CHOLERA MORBUS, EPIDEMIC CHOLERA. 

Intestinal colic. Varied forms and causes 284 

Symptoms and duration 285 

Differential diagnosis 286 

Treatment for the different forms of colic 287 

Cholera morbus. Symptoms. Prognosis 2S^ 

Treatment. Dangers to be anticipated 289 

Epidemic cholera. History. Researches of Koch 290 

Propagation of Asiatic cholera. Comma bacillus 291 

Threatening symptoms. Treatment 292 



CONTENTS. XI 

SECTION V. — DISEASES OF THE ABDOMINAL ORGANS. 
CHAPTER L— ACUTE PERITONITIS, DERANGEMENTS OF THE LIVER. 

Acute peritonitis. Anatomical characters. Symptoms 295 

Fatal signs. Causation. Prognosis 296 

Favorable symptoms. Treatment 297 

Symptoms and treatment 298 

Importance of alkaline saline waters 299 

CHAPTER II. — JAUNDICE. 

The functions of the liver. Forms of jaundice 301 

Differentiation of the causes 302 

Symptoms when associated with inflammation 303 

Prognosis and management 303 

The indications when recovery commences 304 

CHAPTER III. —DISEASES OF THE KIDNEYS. 

Investigations of Dr. Bright 305 

Medical delusions 305 

Acute Bright' s disease. Symptoms and course . . . . . . 306 

Causative influences. Existing dangers 307 

Uramiie poisoning. Treatment 308 

Sir James Simpsons bath 30S 

Chronic Bright' s disease 309 

Commencing stage 309 

Causation. Symptoms and complications . 310 

Diagnosis. Prognosis. Treatment 311 

CHAPTER IV. — DIABETES MELLITUS, DIABETES INSIPIDUS. 

Diabetes mellitus. Characteristic changes in the urine . 313 

Progressive changes and prognosis 314 

Treatment. Bouchardat's dietetic regimen .315 

Epitomized precepts for diabetic patients ......... 316 

Diabetes insipidus. Invasion and symptoms 317 

Origin, prognosis, and treatment 318 



SECTION VI. — DISEASES OF THE NERVOUS SYSTEM. 
CHAPTER I. —APOPLEXY, SUNSTROKE, NEURASTHENIA, YERTIGC. 

Apoplexy. Causative influences 319 

Warning symptoms. Appearance during an attack . . . . • . . 320 

Prognosis. Paralysis. Treatment 321 

Sunstroke. Contributing causes. Symptoms 322 

Average rate of mortality. Treatment 324 

Neurasthenia. General consideration 325 

Vertigo. Unfounded apprehensions. Treatment 326 



HI CONTENTS. 

CHAPTEB II. — EPILEPSY, NEURALGIA. 

Epilepsy. Epileptiform convulsions. Causation 327 

Symptoms of a seizure 32g 

Characteristics of le petit mal 330 

Measures employed for the cure of epilepsy 331 

Neuralgia. Predisposing causes 332 

Premonitory symptoms 333 

Management of an attack 334 

Curative treatment - 334 

CHAPTER III. — HEADACHE, INSOMNIA. 

Varied forms of headache, and symptoms of each 336 

Treatment during an attack and in the interval 338 

A remedy serviceable in all forms §40 

Insomnia. Importance of the subject 340 

Physiological changes which induce sleep 341 

Causative conditions. Treatment 342 

Dietetic and hygienic measures 343 

Sleep-producing agents 344 

CHAPTER IV. —RABIES. 

Historical. Obsolete theories. Cause 345 

Manner in which the poison is communicated 346 

Period of incubation. Forms. Symptoms 347 

Violent stage. Illusions. Self-mutilation 34S 

Characteristic signs 349 

Ancient and unfounded traditions 349 

Course and termination of the violent form 350 

Dumb rabies. Characteristic symptom 350 

Diagnosis. Diseases with which it is confounded ........ 351 

Preventive treatment. Sucking the wound 352 

Groundless or greatly exaggerated terror 353 



SECTION VII. — I. SIMPLE AND PERIODICAL FEVERS. 
CHAPTER L— FEBRICULA, INTERMITTENT FEVER. 

Simple fever. Catching cold. Symptoms 354 

Intermittent fever. Synonymous terms. Preceding signs 355 

Symptoms. Different types. Division into stages 356 

Condition following attacks. Causation 357 

Prognosis. Treatment. Congestive intermittent 35S 

Preventive measures when exposed to malaria 358 

The sovereign remedy 359 

CHAPTER II. — TELLOW FEVER. 

Black vomit. Characteristic appearances 361 

Course. Duration. Fatal signs 362 



CONTENTS. 



xin 



Fatal epidemic on shipboard 
Conditions necessary to propagation 
The importance of judicious nursing 



363 
363 
364 



SECTION VII. — II. CONTINUED FEVERS. 



TYPHOID FEVER AND TYPHUS FEVER. 

Structural changes in typhoid 

Premonitory symptoms. The first week 
Second week. Results of high fever 
The typhoidal state. Third week .... 

Decline of the disease. Fourth week. Causation . 
The germs. Their propagation and mode of infection 
Prognosis. Unfavorable influences and signs . 
Treatment. The importance of judicious nursing 
Measures which are imperatively demanded 
Typhus fever. How transmitted. Symptoms . 
Distinctive differences between typhoid and typhus fevers 



365 
366 

367 
368 
369 
370 
371 
372 
373 
375 
376 



SECTION VII. — III. ERUPTIVE FEVERS. 

CHAPTER I. — SMALL-POX, VARIOLOID, CHICKEN-POX. 

Variola. Varioloid 378 

Efficacy of vaccination 378 

Symptoms present during the course 379 

Contrast between the different forms of small-pox . . . . . . 380 

Hemorrhagic or malignant form 381 

Chicken-pox. General description 381 

Duration. Convalescence. Treatment 382 

CHAPTER II. —SCARLET FEVER, MEASLES. 

How scarlet-fever poison is transmitted . . 383 

Appearance of the eruption 384 

Course and complications 385 

Various sequels. Treatment 386 

Period of danger after an attack 387 

Measles. Contagiousness. Symptoms 388 

Irregularities in development and course • . 389 

Treatment. Popular delusions . . 390 



SECTION VIII. — GENERAL DISEASES. 
CHAPTER I. — DIPHTHERIA. 



Manner of development. Special poison 
Symptoms. Characteristic appearance of the throat 



391 
392 



X.V - CONTENTS. 

Duration. Evidences of blood-poisoning 393 

Prognosis, Unfavorable symptoms. Fatal signs ...... 394 

Distinctive difference between diphtheria and tonsillitis 395 

The dangers of infection. Imperative precautions 395 

Supportive and medicinal treatment 396 

CHAPTER II.— RHEUMATISM. 

Acute articular rheumatism. Causation 398 

Local and constitutional symptoms. Symmetrical course 399 

Duration. Prognosis. Local treatment 400 

Constitutional treatment. Specific remedy 401 

Sub-acute rheumatism. Chronic articular rheumatism 402 

Course, peculiarities, and treatment 403 



SECTION IX. — ACCIDENTAL DISTURBANCES. 
CHAPTER I. — HEMORRHAGE, WOUNDS, BURNS, AND SCALDS. 

Dangers generally exaggerated in hemorrhage 405 

How to control bleeding. Improvising a tourniquet 406 

Advice important to remember. Nosebleed 407 

Wounds. Varieties, and how produced 407 

General treatment. Antiseptic dressing 408 

Burns and scalds. Domestic remedies 409 

Conduct when clothing takes fire 410 



CHAPTER II. — FRACTURES, DISLOCATIONS, SPRAINS, ARTIFICIAL 

RESPIRATION. 

The different forms of fracture. Diagnostic signs 412 

Treatment which should immediately follow the injury 413 

How to adjust splints. Dislocation of the arm 414 

Manner of reducing displacement at shoulder-joint 415 

Sprains. Treatment in suspended animation 415 

Artificial respiration. Marshall Hall's method 416 



CHAPTER III. —POISONS AND ANTIDOTES. 

Poisons defined. Their introduction into the system. Acids 417 

Mineral acids. Permanent injury 418 

Oxalic acid. Hydrocyanic acid. Cyanide of potassium 419 

Tartaric acid. Alcohol 420 

Ammonia. Instructive cases 421 

Antimony. Arsenic 422 

Belladonna. Bitartrate of potassium 423 

Cannabis indica. Cantharides 424 

Chloral hydrate. Chloroform 424 

Colchicum. Conium 425 

Copper. Corrosive sublimate 425 

Croton oil. Kerosene oil. Lead • • • * 427 



CONTENTS. XV 

Lobelia. Opium 428 

Phosphorus. Strychnia ...... .. ... 430 

Tobacco. Nicotine ..-»•. 4:j 1 

Zinc. Poisonous fish. Meats. Mushrooms 432 

Bites of venomous reptiles. Irritant gases A'.','.) 

General rules in cases of poisoning 434 



Appendix 435 

Table of Doses ............ 445 

Index . . ...... ...... 449 



IJSTTKODUCTOKY. 



That much of the suffering of mankind is but the penalty imposed for 
violations of organic law, is a truth with which all intelligent students of 
nature are familiar, and even the careless observer must, in many of his 
afflictions, recognize the relation between cause and effect. The problem 
of life is insoluble, and many of the mysterious influences which shape the 
end of man must ever remain past understanding. With the progress of 
science, however, many truths have been revealed, and numberless fancies 
and prejudices, born of ignorance and superstition, have been dissipated. 
Scientific research and analogical reasoning have shown many ancient 
theories to be untenable, and opened avenues which, when explored, must 
lead to a clearer understanding of the inner workings of life. The diffusion 
of knowledge, of late years, has been rapid and widespread ; few indeed 
can now be found to sustain the once popular theory that disease is a 
special dispensation, or the expression of an offended Deity. A better 
understanding of Nature's manifestations, and of man's inherent powers 
and responsibilities, has taught us that to avert epidemics we must depend 
upon our own efforts and sanitary precautions, rather than upon fasting and 
prayer. To the human constitution a natural period of existence has been 
given ; man from the beginning of his being is subject to the ordinary laws 
of Nature. He is endowed with those qualities essential to the sustenance 
of self, in the usual experiences of life, and, while ever subordinate to the 
Divine Will, he yet exists independently as it were, under the domain of 
his own intellect. He is, in a measure, physically as well as mentally, the 
arbiter of his destiny. As his mind expands, so may his body grow in 
strength, perfecting development and acquiring a higher degree of vitality, 
which makes it more powerful to resist those accidental infirmities to 
Which all are liable. The physical structure of man may, not improperly, 



XV111 INTRODUCTORY. 

be likened to his earthly dwelling. He can build for himself a house which, 
with care and judicious management, will be serviceable for many years — 
at least, during his natural period of existence. Neglect is, however, soon 
apparent ; it the glass is broken and is not replaced, if the roof leaks and 
no effort to repair it is made, then, in the fierce storms which beat upon 
the house, the wind and the rain will enter, and consequent decay will be 
inevitable ; but a few years need pass before the building is unsightly and 
uninhabitable. So, too, with the body of man ; if it becomes deranged, and 
even seemingly unimportant infirmities are neglected, structural changes 
occur; then follows a long line of ailments, evidences of decay, which 
eventuate in the utter destruction of all vital forces. 

The first duty of man is obedience to Nature's laws, and without sub- 
mission to this divine decree, continued enjoyment of health, and the full 
measure of life, are impossible. For the violation of these laws there is a 
fixed penalty, which will inevitably be enforced; there is no escape from 
the punishment justly merited by transgression. It may be delayed; 
days, even years, may pass before the consequences of evil habits are 
apparent; their ultimate manifestation, however, is ascertain as the end 
of life. The abandonment of principle which characterizes many in their 
disregard of the laws of health, sadly contrasts with their earnest efforts to 
conscientiously perforin religious and social duties; physical and moral 
laws are alike divine, and violation of either is a sin. While, doubtless, 
no inconsiderable portion of mankind knowingly and wantonly indulge 
their appetites and inclinations to the detriment of health, it is believed 
that the mass, which is very largely composed of fairly well educated and 
intelligent people, do so through ignorance, of which they are utterly 
unconscious. Prominent and grievous is this fault at the present time ; 
but the consciousness that it is much less apparent than in the past is a 
source of congratulation for the intelligent observer. Improvement, while 
possibly slow and gradual, is yet very marked. The general public are, 
year by year, better instructed in hygiene and the care of the sick. The 
endeavors of physicians to avert disease by timely preventive measures, 
are, at the present time, better appreciated by non-professionals ; the more 
intelligent recognize the obligation which is imposed upon them for their 
protection. 

The leading design of this work, as implied in the title, is to place 
before the reader those established principles a knowledge of which is 



INTRODUCTORY. XIX 

essential to the preservation of health, and to recovery when suffering 
from disease. Under Practical Hygiene, the most common substances 
nsed for food, and their peculiar action on the system, are considered. 
The laws of diet, the importance of a careful observance of which is but 
imperfectly appreciated by mankind in general, are also set forth. In the 
same connection personal hygiene is dwelt upon, with the purpose of pro- 
moting correct physical habits, which are all-powerful in the prevention of 
disease. Under Mental Hygiene, the intellectual operations are consid- 
ered, as a knowledge of the necessary relationship between the mind and 
the body is essential to a correct understanding of the human constitution. 
The directions on the General Management in the Sick-Room are practical 
and minute; rarely indeed are people conversant with those duties upon a 
faithful performance of which the comfort and recovery of patients very 
often depend. The importance of dietetics in the treatment of disease 
cannot be overestimated ; and the discussion of invalids' foods, their 
preparation and administration, occupies the space which its importance 
demands. 

A careful study of the principles of medicine cannot be too strongly 
advocated ; a knowledge of them is indispensable to a correct application 
of the teachings which are embodied in Book Fifth, devoted to the Practice 
of Medicine. It is not the design of the author to attempt to educate 
the reader to be his own physician ; in a great measure, it would be 
impracticable. He should, however, possess a general knowledge of the 
causes, nature, and treatment of diseases more commonly encountered. 
In America, especially, where no legal safeguard exists to prevent the 
fatal mistakes of irresponsible pretenders, who are allowed to practise at 
will upon unsuspecting victims, individual safety demands even more than 
an ordinary familiarity with the characteristic appearances presented by 
disease. 

It has been said that quackery is stimulated by opposition ; the truth 
of this assertion has been clearly proved. Every effort to secure stat- 
utory regulation, at least in the commonwealth of Massachusetts, has 
failed. Never, as yet, has the cause been tried before a tribunal composed 
of men intelligent enough to discern that the claims of charlatans for 
recognition were based solely upon arrogance, assurance, and transparent 
sophistries. In consequence of this criminal inefficiency betrayed by 
those entrusted with the legal protection of the people, countless lives 



\\ [NTRODUCTOBY. 

are sacrificed upon the altar raised to man's stupidity. Every trade is 
represented in the ranks of medical pretenders. The evolution of the 
groom and blacksmith of to-day, eminently fitted for their several duties, 
but for none higher, is often marvellously rapid ; without any preparatory 
teaching whatever, they usurp, without opposition, the right to assume on 
the morrow that title which is no longer the distinctive sign of skill and 
scientific attainment. In the city of Boston, at the present time, there 
are six hundred quacks practising as physicians. This number does not 
include the mind-readers, clairvoyants, Christian Scientists, and other 
arrant knaves, whose signs are conspicuously exhibited on every street. 
Tlie columns of the daily papers are filled with ingeniously framed adver- 
tisements, and the number of people who fall easy victims is countless. 
Xo remedy exists for this deplorable state of things. The vile and igno- 
rant pretender has an equal right, in the absence of law, to assume the 
care of the sick, as the graduate of Harvard, who has completed a four- 
years' course of study, and a year of preparatory service in a prominent 
hospital. Protective legislation is denied ; relief, if it comes to communi- 
ties, can onlv be had through individual enlightenment. Ignorance of the 
nature of disease is a condition favorable to the propagation of quackery, 
and only by self-education can the people secure immunity. 

From the earliest years of his professional life, the author has been con- 
scious of the gravity of this existing evil ; it has been his cherished hope 
that he might be permitted to strike a blow which w r ould be felt by char- 
latans, and, to some extent, defeat their machinations. With that pur- 
pose ever before him, he has prepared this work. He lends his efforts to 
assist the reader in educating himself to a proper understanding of the 
more common diseases, and the general treatment which they demand. 
With such a knowledge acquired, he can subdue the more common ail- 
ments ; when threatened with severe disease, and a physician is in atten- 
dance, he can discriminate between the ignorant pretender and the skilled 
professional, — escape the one, and second the efforts of the other. 

The general rules of treatment have been advised in all the diseases 
considered, it being assumed that, in occasional cases at least, to secure 
competent medical assistance will be impossible. A responsibility has been 
recognized, and the danger of encouraging the reader to assume the sole 
care of serious disorders has been fully appreciated ; in some instances, the 
medicinal treatment has been withheld, to emphasize the need of profes- 



INTRODUCTORY. 

sional control. In accidents involving danger to life, or deformity, ili< 
procedure advised is for the government of friends until ;i surgeon can 
assume the care of the sufferer. It will be observed that many prescrip- 
tions have been introduced; they are in Latin, and symbolized. This has 
been deemed necessary to avoid errors, as, when a mixture is needed, 
there will be no necessity for the reader to copy the formula, but it can be 
prepared by the chemist from the printed page. 

The author is of the regular school. The literature of his creed is 
exhaustive ; for hundreds of years, works on the practice of medicine have 
been accumulating; upon almost every subject pertaining to the art, vol- 
umes have been written and re-written, in countless repetition. To prepare 
an original treatise on hygiene and therapeutics would be impossible ; but 
little more than a compilation is attempted. In this work are incorporated 
those important truths which have been transmitted, and are the common 
heritage of all students of the science of medicine. To these are added 
the results of personal observation during the author's professional life. 

It has been the author's endeavor to condense the work into as small a 
compass as possible, and the discussion of many diseases, rarely encoun- 
tered and with difficulty recognized, even by the most skilful physicians, 
has been omitted. Nearly all household guides, popularly termed " doc- 
tor books," discuss obscure diseases, and contain frequent expressions of 
a character which renders their concealment from the eyes of children 
imperative. All indelicate allusions have herein been studiously avoided ; 
not a single precept has been conveyed which may not properly and wisely 
enter into the education of the growing youth. 

With this brief exposition of the purposes of this work, it is submitted 
by the author. The ardent hope is indulged that his effort will prove 
instructive, and that he will be permitted to contribute to the welfare of 
the general public. 

Author. 



A FRIEND IN NEED. 



PRACTICAL HYGIENE, 



BOOK FIRST. 



CHAPTER I. 
FOOD. 



" That the health of every person depends much on the quality and 
quantity of his diet," is an axiom of infinite importance which should be 
impressed on the minds of all. An exhaustive dissertation on the subject 
of food is neither within the limits of this work, nor does a scientific trea- 
tise, replete with technicalities, promise exceeding value. On these pages, 
in simple and comprehensive language, the purpose is to place before the 
reader those important and established principles, a knowledge of which 
is absolutely essential to a correct interpretation of dietetic law. 

Nature has imposed certain obligations; none can evade them, and 
they who would enjoy perfect health must first learn submission to her 
will. By virtue of her right she exacts perfect obedience, and sooner or 
later punishment will inevitably follow transgression. He who disregards 
her laws, may at first seemingly escape the penalty, or, should he experi- 
ence suffering, he may not recognize the relation of the cause and the effect, 
yet the consequences of his violation, although delayed, cannot in the end 
be evaded. 

The term "food" properly includes all substances, solid and liquid, 
which are necessary to sustain the process of nutrition. To satisfy the 
requirements of life, those materials are indispensable which contain the 
elements which form the constituent parts of the living frame. Certain 
substances are first in importance as articles of food, because they contain 
elements which constitute the largest part of the entire mass of the body, 
and exhaustion follows more rapidly when they are withheld. Although 
the system be well supplied with these, there are others, the want of 
which is felt sooner or later, and they are as necessary to the continuous 
maintenance of life. 

In no one article of food is embodied all the needed constituents suffi- 
cient for the nutrition of the body. Some have certain elements in excess, 
and yet are deficient in other essentials. Food, to be nourishing, must con- 

1 



FOOD. 

tain all the principles, and in order that the tissues and fluids of the body 
m:i\ remain in a healthy condition, and perform their proper parts in the 
functions of life, they must be supplied with the ingredients necessary to 
their constitution. It the system is deprived of one minute essential, 
starvation, although less rapidly, will just as surely follow as though it 
were deuied the constituent first in importance. 

The nutritious character of any substance, or its value as an article 
o\ iooA, dors not depend simply upon its furnishing any one nourishing 
element in excess, but upon its containing them mingled together, in such 
proportion as is requisite to promote the growth or repair the waste of the 
body. It is only in a state of combination that the elements are service- 
able as food. 

In estimating the value of any substance as an article of food, it is 
ssary to consider its digestibility. There are many substances which 
contain nutritious matter in abundance, yet, being either insoluble or acted 
upon so slowly by the digestive fluids, their virtues cannot be extracted. 

Digestion is a process by which substances entering the stomach are 
so changed, they can be absorbed from the intestinal canal and taken up 
by the blood vessels. Some articles of food are readily absorbed, others 
need more than the action of the digestive fluids, resisting the process 
until they have been liquefied and otherwise transformed. Much of the 

f 1 of man may properly be considered solid and insoluble when it enters 

tomach. Many articles of diet, which are naturally fluid, are coagu- 
lated and solidified by the process of cooking. 

To fully understand the manner in which digestion takes place, a hasty 
study of the organs concerned in that process is essential. In the human 
species the food contains both animal and vegetable substances. After 
entering the mouth and in its passage downward along the great canal, by 
winch it is conveyed through the body to the point from which the useless 
parts are evacuated, the food meets with live different digestive fluids. 
Its different elements are digested in various parts of this canal by the 
agency of these fluids, each having its especial office in the performance of 
the operation. 

To prepare the food for digestion, it is masticated and broken into 
small ] /articles by the crushing action of the teeth, a necessary operation, 
since the digestive fluids act more promptly and efficiently if it is finely 
divided, than if it enters the stomach in a solid mass. On certain articles 
of food mastication must needs be prolonged, animal matter especially re- 
quiring more effort. Vegetable substances, by the process of cooking, are 
led, more easily separated, and less grinding is necessary. 

"While the food is in the mouth and being masticated, it meets the first 

ve fluid, viz., the saliva. This fluid is made up of four others, the 

secretions of three sets of glands and of the mucous membrane. Its function 

is t> moisten the food, assist in grinding it, and, by lubricating the mass 



THE RESEARCHES OF DR. BEAUMONT. 3 

crushed by the teeth, render its passage into the stomach easier. The quan- 
tity of saliva secreted during twenty-four hours has been estimated as three 
pounds avoirdupois. It is poured out by the glands in great abundance 
during mastication, the proportion being influenced by the hardness and 

dryness of the substances taken into the mouth. The sight and odor of 
food when the appetite is excited, will also greatly increase the quantity of 
this secretion. 

The saliva has a chemical property which enables it to convert starch 
into sugar. When the fact was first discovered, it was supposed that the 
function of this secretion was the digestion and liquefaction of starchy 
substances. This theory was soon disproved, and it is now accepted that 
the property is accidental rather than essential, and the office of the saliva 
is purely mechanical. It assists the teeth, and acts as a vehicle to convey 
the particles of food through the passage from the mouth into the stomach. 
During mastication, while the jaws labor, the tongue and the teeth are 
active, and the substances operated upon are by them kept in constant 
motion, until finally reduced to a soft pasty mass. 

The knowledge of that part of digestion which takes place in the 
stomach was vague and speculative, until the misfortune of one man ren- 
dered a course of experiments possible, the results of which settled ques- 
tions hi dispute, and enlightened the world to an accurate understanding 
of the functions of that important organ. The unfortunate man was 
Alexis St. Martin, a Canadian boatman, who had a permanent opening into 
the stomach, the result of an accidental gunshot wound. The musket, 
which was loaded with buckshot at the time of the accident, was dis- 
charged at the distance of a few feet from St. Martin's body. The wound 
involved the cavity of the lung, the diaphragm, and the great pouch of the 
stomach. Recovery took place, but there remained a permanent opening, 
of about four-fifths of an inch in diameter, leading into the stomach. This 
was usually closed by the protruding mucous membrane, which, while it 
acted as a valve, could be readily depressed at any time. Through this 
opening the contents of the stomach were easily extracted for examina- 
tion. 

Dr. Beaumont, of the United States Army, rendered his name immor- 
tal by the experiments which he instituted on St. Martin, at various 
intervals between the years 1825 and 1832. The facts which he established 
were all of great practical importance; through him it became positively 
known that the active agent in digestion is an acid fluid, secreted by the 
walls of the stomach, and that this fluid is poured out from the walls of 
that organ only during digestion, and under the stimulus of food. 

The investigations of subsequent years confirmed the experiments of 
Dr. Beaumont. The lower animals have been used as materials to favor 
research, it being discovered that a permanent opening into the stomach 
was a simple operation, and that the health of the animal need not suffer 



4 FOOD, 

from it. It lias been determined that the gastric juice has two indispcn- 

ingredients, viz., pepsin and an acid. Pepsin is secreted in the 

- eculiar to it, and obtainable only from that organ. The acid 

has no especia] peculiarity; by one authority it is affirmed to be only 

hydrochloric and lactic acids, and these, with pepsin, constitute an active 
_ si ive fluid. 

solution, then, oi certain elements of the food in the stomach is 

:ted by the gastric juice a fluid which owes its virtue to pepsin and 

an acid. Its action is favored by the elevated temperature of the body, 

also by the movement to which the contents of the stomach are subjected. 
The muscular fibres in the walls of that organ are so arranged, that, by 
alternate contraction and relaxation, the masticated food is constantly 
churned, as it were, by being carried backward and forward to every part 
of the st«»mach, and rapidly mixed with the gastric juice poured out by the 
mucous membrane. 

The food, kept constantly in motion, is swept around by two currents; 
one impels that part of the mass which is above the middle, along the upper 
curve of the stomach; the other moves in an opposite direction, carrying 
the remainder along the bottom curve. The time occupied in making the 
circuit is estimated to be three minutes. By this continued movement, the 
fluid is made to penetrate every part of the mass upon which digestion is 
employed. This gentle movement continues until the stomach is com- 
pletely empty, becoming less active towards the end of digestion, and when 
at last its work is ended, the organ returns to a state of quiet. 

The length of time required for stomach digestion varies- from one to 
five hours and a half, according to the kind of food acted upon. This fact 
was determined by Dr. Beaumont, who. by examining the contents of the 
stomach of St. Martin at various intervals after feeding, was enabled to 
prepare a list showing the comparative digestibility of different substances. 
According to him, the time required for digestion of the most important 
articles of food is as follows : — 

Kind of Food. Hours. Vlin. 

Pig's feet 1 00 

Tripe 1 00 

Trout (broiled) . 1 30 

Venison steak 1 35 

Milk 2 00 

Koasted turkey 2 30 

beef 3 00 

mutton 3 15 

Veal i broiled i -1 00 

Salt beef I boiled) 4 15 

Boasted pork 5 15 

Considering the temperaments ami individual peculiarities which are 
influential on digestion, the length of time occupied in the operation must 



THE PROCESS OF DIGESTION. ;"> 

needs vary somewhat in different persons. The list undoubtedly gives a 
correct average estimate of the time required under ordinary conditions. 

The food remains in the stomach until reduced to a fluid, after which it 
is forced into the upper bowel. This product of gastric digestion is called 
chyme. Besides the elements entirely dissolved, it contains sonic others, 
finely subdivided, which have not yet undergone solution; also in the same 
state those constituents of the food which resist the solvent action of tin- 
stomach, and which must be submitted to the intestinal fluids before 
digestion can be completed. 

The chyme, containing those portions of the food which left the 
stomach in an undigested state, is next submitted to the fluids of the small 
intestine through which it passes. The process of digestion which follows, 
may be regarded as supplementary to that which has already been per- 
formed. Soon after entering the small intestine the liquefied food meets 
and is acted upon by the bile, pancreatic, and intestinal juices, each having 
its especial part in the function of continued digestion. 

Thus the food, through the agency of the stomach and the intestine, 
undergoes conversion into a principle called aibuminose, so minutely sub- 
divided and diffusible, it is readily taken up by the small absorbent vessels 
and through them enters the circulation. The process of absorption is hast- 
ened by the peculiar movements of the intestine, a slow, worm-like creeping 
motion, induced by successive contractions and relaxations of the muscular 
fibres in its walls. By this action, the substances after leaving the stomach 
are steadily carried downward, traversing the entire length of the small 
intestine, and brought in contact with the whole extent of its mucous 
membrane. The surface of the intestine, by being largely folded, is greatly 
increased, and thereby absorption is favored. The liquefied portions of the 
food, in their passage downward, are constantly being taken up by the 
absorbent vessels, and finally, when the end of the small intestine is 
reached, there remains only the indigestible portions, together with the 
refuse of the intestinal secretions. 

Many articles of food, nutritious in character, are, while in their nat- 
ural state, highly indigestible. They must be softened, and their integrant 
parts separated, before the digestive fluids can act upon them successfully. 
The process of cooking accomplishes several important results. By it 
many substances, which in the raw state are insipid, acquire an agreeable 
taste and a high flavor. Again, by a skilful preparation of food, it becomes 
pleasing to the eye, and its tempting appearance stimulates the appetite ; 
one will naturally turn from a table loaded with viands carelessly served 
and uninviting. 

By cooking, the vegetable substances are softened, and easy mastication 
is favored. Their inner structures are loosened, and thereby the penetra- 
tion of the digestive fluids is facilitated. Starch is the ingredient of which 
vegetables are largely composed; in the raw state the granules are encased 



FOOD. 

in a hard resistant covering, which, under the process of cooking, becomes 
ruptured by the swelling of its contents. 

( king meat changes the connective tissue into gelatine, and the mus- 
cular fibres tall apart. It also coagulates the elements called albuminoids. 
"Without the usual preparation meat is tough, stringy, to a certain extent 
• b1 ss, and difficult both of mastication and digestion. Parasites, or 
their germs, often lodge in substances used for food, and the high tempera- 
ture to which they are exposed in cooking causes their destruction. The 
warmth imparted to food also aids digestion, and adds to its stimulant 
properties. 

( king meat is an art of which by far too many are ignorant: its 
seeret is to avoid as little loss as possible of the nutritive principles. 
Roasting causes the least change, as the elements at the surface become 
coagulated and form a crust, confining within all the juices. Putting meat 
into boiling water is almost like roasting; a crust by this process is also 
formed. If the same is placed in cold water and then gradually heated, the 
result of the boiling is soup ; the nutritive properties pass into the water, 
and the meat is reduced to an insipid residue. 

Clear soup is devoid of all nutritive properties, the virtue of it being 
removed in skimming. Liebig's extract is clear soup boiled down, and is 
therefore only a stimulant. A series of experiments made on dogs devel- 
oped the fact that those fed on meat extracts died more quickly than those 
entirely deprived of food. 

A- beef-tea is commonly prepared in the sick-room, it is useful only as a 
stimulant, and even that property is often much exaggerated. To prepare it 
properly, but little heat ought to be used. The meat should be placed in a 

sel and covered with cold water, then be allowed to simmer for a short 
time, until the muscular fibres appear blanched. The next step is to 
squeeze it through a cloth, and the liquid thus secured is beef-tea. This, 
when properly flavored, is palatable, and has nutritious properties. 

Fried food is not generally acceptable to the stomach. It is commonly 
loaded with fat or oil, which causes the substances to resist in a measure 
the gastric juice. Again, the fat used in the process often decomposes 

ewhat, and the products are badly tolerated by the stomach. This 
fact, after eating fried food, is often evinced by heart-burn, and an acid 
taste which is experienced as gas is raised. 

Food when properly stewed is in a state favorable for digestion. Sim- 
mering only is allowable ; boiling renders the meat tough and hard, whereas 
it should break down easily. The warming-over process after hashing has 
the same principle as stewing, the articles being stewed in their own vapor. 
Meat enclosed in a tightly covered dish which is submerged in boiling 
water, and in this way allowed to cook, is especially soft and tender: in the 

•1 is retained nearly all the nutritive elements. It is the custom of 
to roast meats for a short time and then enclose them in dishes 



THE NATURAL DIET OF .MAN. 7 

especially constructed, with spaces filled with water, through which the 
heat is communicated. Not only can the process of cooking be com- 
pleted in this way, but also, by nicely adjusting the amount of heat, 
meats so enclosed can be kept warm, juicy, and tender for many hours 
after. 

In the preservation of food by agents which prevent decomposition, 
much of the nutritious virtue is destroyed. The effect of salt is to extract 
certain elements, harden the fibres, and render the substances more difficult 
of digestion. Liebig estimates that the loss of nutritive value by the use 
of brine is from one-third to one-half. 

Food salted or dried is, with but few exceptions, so hardened cooking 
cannot correct the condition, and its digestibility is permanently impaired. 
For this reason it is forbidden persons disposed to dyspepsia. At this 
point it may be said that to maintain perfect health it is necessary that a 
portion of the food consumed by man should be in the fresh state. This 
applies alike to animal and vegetable substances. The changes which they 
undergo in the processes of salting, smoking, and drying, render them unfit 
for the prolonged maintenance of health, and fresh articles must enter into 
the diet, or scurvy and kindred disorders will result. The demand for 
these must needs vary ; often a small quantity will for a time suffice. The 
efficacy of lime juice to correct the condition induced by an excess of pre- 
served food is well known. 



THE NATURAL DIET OF MAN. 

That a mixed diet is the best for man is a fact recognized by all. 
While certain substances used as food contain all the elements necessary 
to maintain nutrition and repair bodily waste, in no one is the balance of 
principles so nicely adjusted, man can be confined to it indefinitely without 
injury to the organs of digestion. 

The nutritious value of a substance as an article of food depends much 
upon its concentration. A person could subsist long upon meat alone, but 
the quantity would need to be from four to six pounds per day, to supply 
the body with the elements indispensable to its integrity. Eggs would 
form a completely nourishing diet, but if restricted to them, twenty-one 
would be needed per day. Milk builds up bodily tissues, but they cannot 
withstand hard labor, and soon weaken. At least a gallon would be 
demanded to supply the body with nitrogen. 

Thus it will be seen that no one article of food contains all the elements 
necessary, sufficiently concentrated to meet the limits of digestibility, and 
maintain perfect bodily health. In some substances certain nutritious 
principles exist in excess, while other elements are not freely supplied. A 
combination of several distinct substances promises adequate and uniform 
support. 



S POOD. 

The question naturally arises, what are the most important articles of 
food demanded for bodily nutrition and the repair of tissue waste? An 
answer necessitates a consideration of those substances commonly eaten by- 
man, ami an estimate o( the virtues of each class. 

The food consumed by the human race is found to vary greatly in dif- 
ferent parts o\ the world. Some subsist wholly on meat, others on vege- 
table substances, and still others are sustained by a mixed diet. The 
so-called vegetarians, who are by no means numerous, find arguments to 
sustain the principle of their manner of living. There are other people 
who consider meat as the only food from wdiich they can derive nourish- 
ment and muscular strength. Neither extreme can properly be accepted, 
and physiological considerations indicate that a mixed diet, composed of 
both vegetable substances and meat, is in harmony with the nature of man. 
It i- upon this he appears to fully attain perfect physical development and 
intellectual vigor. 

The proportion of each, then, becomes an important question, which 
the best of authorities have decided. They claim that one-fourth only of 
the diet of man should be animal food, and that more than this amount 
would be unnecessary to jjerfect health, and interfere with the proper per- 
formance of the functions of certain organs. 

Food is divided into certain classes as follows : — 

1st. Flesh ; the muscular substance of other animals. 

2d. Viscera (internal organs) of the mammalia (animals which suckle 
their young) ; such as liver, kidney, brain (sweetbread of young calf), etc. 

3d. Eggs; hen's, bird's, pigeon's; also those of reptiles, such as turtles. 
Eggs of fishes (caviare), sturgeon. 

4th. Milk derived from animals, and its products; such as butter, 
cheese, etc. 

5th. Cereal grains and products; among them wheat, rice, barley, 
oats, etc. 

6th. Leguminous seeds ; beans and peas. 

7th. Roots (all underground) ; such as tubers, potatoes, beets, carrots, 
parsnips, etc. 

8th. Herbaceous articles ; cabbage, spinach, celery, etc. 

9th. Fruits of forest and orchard ; apples, pears, and nuts. 

10th. Oils (pure fats) ; olive oil, vegetable; cod liver oil, animal. 

To sustain the body there are also needed mineral salts and w r ater. 

According to the foregoing arrangement the more common articles of 
food included in the first class are meat, poultry, game, wild-fowl, fish and 
shell-fish. By still furthur subdivision, it may be said that meats con- 
& beef, mutton, veal, lamb, pork, bacon, and venison. The flesh of many 
other animals than those yielding the meats herein named is used as food, 
but to a much less extent, and a separate consideration is unnecessary. 



JEWISH CUSTOMS. ( .l 

The value of meats as articles of food is influenced by a variety of 
conditions. The flesh of young animals, generally more tender, ig 
easy of digestion, and lacks many of the nutritive principles found in that 
of the old. In poultry and game, especially, the sex influences the qualit) 
of flesh; in fact in all animals the muscular fibres of the female are finer 
and more delicate. In larger animals the muscles are invariably coarser 
than in the smaller, even in the same species. 

The value of flesh of all animals as food is less at certain periods 
of the year, and hence the common expressions, in season and out of 
season. A marked difference is to be observed in the flesh of wild 
animals and those domesticated. That of the former has a richer, stronger 
flavor, and less fat is deposited in the tissues. Again, in a hunted ani- 
mal, driven to violent exertion before death, the flesh is of greater ten- 
derness. 

The influence of certain kinds of food upon flesh is well known ; if this 
knowledge were practically used by all, the gain would be significant. 
The pig, when reared for the purpose of food, should be confined to 
vegetable substances fresh and wholesome, whereas the vilest refuse too 
often constitutes his diet. 

The Jews, by a strict law of their religion, are forbidden to eat the 
flesh of animals from which the blood has not been drained away in 
slaughtering. The killing must also be done by men of their own persua- 
sion, appointed and instructed by their church. In the large abattoirs 
these chosen disciples are stationed, and they follow the most exact methods, 
some of which are absurdly ridiculous. Death must follow one cut only ; a 
second is forbidden. The knife used must be kept sacred for this purpose, 
and any other employment would defile it beyond redemption. After the 
killing, the oflicer of the church makes first a thorough external examination, 
and then through an opening in the abdominal cavity he thrusts his arm 
and feels each organ, doubtless satisfied that with the ends of his fingers 
alone he detects those organic changes many of which can only be detected 
under a microscope. His duty ends with affixing a seal, and woe be unto 
the Jewish provision dealer who sells from his store meat from which this 
evidence of inspection is absent. The same rigid practice is followed in the 
killing of fowls; it must be done solely by appointees especially quali- 
fied. " 

Some claim that this custom has advantages, the flesh of animals so 
slaughtered acquiring thereby an improved delicacy of flavor. This is a 
point on which all will not agree ; certain it is that meat being deprived 
of its blood loses much of its nutritive value. 

Within a few hours after death the flesh of animals hardens, the fibres 
becoming rigid, set by the so-called rigor mortis. This state passes off 
after a few days, and cooking should be delayed or the meat will be hard 
and tou«;h. 



FOOD. 



MEATS. 



A rthes general remarks, it remains to briefly consider the various 
kinds of meat which more commonly enter into the diet of man. 

Beef being made up of closer muscular fibres, less of it is demanded 
' - tisfj hunger. It is generally believed to take precedence as being 
the richest in strengthening properties. This estimate is based on assump- 
tion, and of its correctness there is no positive evidence. 

M tton, it lean, is more easy of digestion than beef, and for that reason 
i< preferred by the dyspeptic. It is a meat probably most indulged in 
during training, doubtless for the reason that over-eating is less liable to 
be followed by disturbance of the digestive powers. 

V > and Lamb. As has already been stated, the flesh of young ani- 
mals, while very tender, is wanting in nutritious properties. It is also less 
easily digested, for which reason it should be sparingly indulged in. 

Park, as shown by the table prepared by Dr. Beaumont, is of all meats 
the must slowly digested. It taxes the stomach severely, and only by those 
in whom the function of that organ is most vigorous and active, can it be 
digested without some manifestation indicative of disturbance. 

H -on. The rule that preserved foods are less digestible finds an ex- 
ception in bacon. It is quite well borne on the stomach, and very popular 
with many. The actual value of bacon for food is influenced much by the 
manner in which the animal yielding the meat is fed. Bacon made from 

- confined contains less oil, and therefore more eatable substance remains 
after frying. In the western country pigs are allowed to run wild through 
the timber lands. The ears of dams are so notched each ranchero can 
recognize his own, and only when pork is needed are the animals secured. 
Meat from them is much richer in flavor; the food upon which they sub- 

is largely acorns. After cooking, very little but oil remains; it is there- 
fore necessary to shorten the process, " barely warming it," as the natives 
advise. 

Venison is of rich flavor and very easy of digestion. The flesh is less 
juicy than beef, and the preparation of it is limited to certain processes; 
to supply the deficiency of fluids, wine is often used in cooking. The meat 
should always be served in a "brazier," by the means of which it is kept 
warm, more palatable and tender. 

Bones. Parkes states that twenty per cent is an average estimate of 
the relative amount of bone in animals. According to Letheby, "it is rarely 
less than eight per cent in any of the various joints. In the neck and 
brisket of beef it is about ten per cent, and in shins and legs of beef 
it amounts to one-third or even one-half of its total weight. In the 
of mutton and pork, the leg is the most profitable, and then the 
shoulder." 

If broken up into small fragments and boiled for manv hours, bones 



POULTRY AND ( I A M E. 1 1 

yield a considerable amount of nutritive matter. The basis of soup is 
gelatine, a jelly-like substance which is found on cooling. 

Blood. Certain nations use the blood of animals, more especially that 
of the pig and bullock. It is an ingredient which enters largely into the 
composition of a sausage of which the Germans are very fond, called 
"blood pudding." There are some persons who attribute to fresh blood 
the most eminent curative properties. These congregate at abattoirs to 
drink of it as it pours from the slaughtered animals. Xo reliable evidence 
has yet been submitted in proof of the especial efficacy of this fluid as a 
remedial agent. The blood is rich in nutritive principles, and has there- 
fore sustaining and strength-yielding powers. It is active in proportion to 
its nutriment, and probably possesses no other virtue. It is especially the 
case in chronic pulmonary diseases that sufferers are very slow to recog- 
nize the significance of symptoms, and seldom realize their danger until 
the last stage is reached. Considering this fact and how tenaciously they 
cling to life, strong in the hope of recovery, consumptives are chosen sub- 
jects fit for powerful mental impressions. The so-reported wondrous 
results from drinking warm fresh blood are doubtless with but few excep- 
tions gross exaggerations, and, in the exceptional cases, to the mental influ- 
ence must be attributed much of the benefit received. 



POULTRY AND GAME. 

The flesh of birds is an important constituent of the diet of man. It is 
easily digested, but less nourishing than that of quadrupeds. On account 
of their constant activity, the muscles of the whole winged tribe are drier, 
fat never being intermingled with the fibres. 

The dietetic value of the flesh of birds in a measure depends on the 
nature of the food upon which they subsist. It is a well known fact that 
during the fruiting season of certain poisonous shrubs the berries which 
they produce are eaten by birds, the flesh of which is thereby rendered 
unfit for the consumption of man. After the season has passed and the 
berries can no longer be obtained, the noxious elements acquired by these 
birds are eliminated, and their flesh can be safely used as food. 

Both the flesh and eggs of fowl are much improved in quality by proper 
feeding. In their care, economy even suggests the wisdom of providing 
them with wholesome substances, rather than force them to subsist on 
refuse. With birds, as with most animals when taken from their wild state 
and fed in captivity, their flesh loses much of that peculiar flavor so char- 
acteristic. 

The meats yielded by tame and domesticated fowls are generally easy 
of digestion. An exception may be made of ducks and geese, the flesh o\ 
which is hard, rich, of ranker taste, and more indigestible. The flesh 
of fowl, turkey, and guinea-fowl, is white, and while less stimulating and 



12 OD. 

nouris ban the meat of animals, it is well adapted as food for all, 

it is properly served. 
method of cooking, as by this process the juices 
and the flavor - I. The dressing with which fowl are 

sists _ lients which tax the stomach 

a 

a marked but agreeable flavor, which in- 

- s by keeping. This varies in different birds, being especially delicate 

- me and more prominent in others : each has special qualities which 

• taste. The flesh of the partridge and quail is of rare delicacy, 
that of the woodcock and snipe is richer and of stronger flavor. The 
- - : strong and slightly bitter taste. 
The richi - game in a measure depends upon the length of time it 
is kept after being killed. Some epicures insist that the partridge and 
quail should be allowed to hang by the head until the neck yields and the 
m it. As this result is effected by decomposing changes, the 
red thereby less digestible. If the meat of game birds is to 
be used for invalids or dyspeptics, it should only be kept long enough to 
me tender. Wild ducks are to be preferred for eating while in a fresh 
state, 9 tl fl sh by keeping soon becomes too strong and has a pro- 
nounced fishy taste. 

A very great number of birds are user] as food, but less commonly, and 

- ecial mention is unnecessary. It may properly be said that the flesh of 

all birds can be safely eaten unless some poisonous properties are taken 

them in feeding. 

The pigeon, which cannot be considered either game or fowl, yields 

meat te- ry and easily digestible. The squab is a valuable article 

for invalids, and convalescents can generally digest it when poultry 

and beef cannot be borne. 

The flesh of rabbits and hares is nearly devoid of fat, and from the 

- -ness of the muscular fibres it is somewhat slowly acted upon by the 
digestive fluids. The meat of the hare has an agreeable flavor, and 

- stimulating properties ; that of the rabbit is less pleasing to the 

- sf 

FISH. 

It is believed that the value of fish as an article of food is not duly 

nated by all. According to the statement of Dr. Davy, those races of 

i ho by necessity are forced to live chiefly if not solely on fish are 

_. healthy, and prolific. In no other class than in that of 

fishen - larger families, handsomer women, or more robust, active 

men. 

That the quantity of meat derived from warm-blooded animals con- 
sumed by many | - far in excess of nature's demands, is a fact be- 



REGULATION OF DIET. 13 

yond dispute. Obedience to dietetic law is by no means difficult, and 
only those with morbid appetites and abnormal cravings will find it a 
hardship. 

The limits, while broad, still exist, and whoever seeks perfect health 
must expect to confine himself to them. Extremes must be avoided; 
rigid denial and gross indulgence are equally forbidden. 

By experiments performed it has been proved that for a man in full 
health, taking active exercise in the open air, from twelve to sixteen ounces 
only of meat is required in twenty-four hours, when living on an exclusive 
diet of bread, fresh meat, and butter, with coffee and water for drink. In a 
diet limited to these substances, more meat is demanded for nutrition than 
would be actually necessary were other articles of food allowed to enter 
into it. 

Among the classes favored by circumstance, and able to indulge in the 
luxuries of life, how few there are who eat no more than twelve ounces of 
meat daily. With many, it constitutes the principal ingredient of two 
meals at least each day, and some deem it essential to every meal. The 
errors of this habit will be more fully discussed in the chapter devoted to 
the consideration of the proper quantity of food. It is only necessary at 
this point to weigh carefully the physiological fact that meats relatively 
tax the digestion more than other substances used as food. 

The purpose for which the digestive organs were designed, is to pre- 
pare food for conversion into the substance of the body. It is reasonable 
to suppose that their duty each day is practically ended when the demands 
of nature have been satisfied. With this faithful performance man is 
rarely content, but he often imposes upon these organs tasks under 
which they patiently labor until completed, or exhaustion suspends th en- 
action. If rest is imperative, only sufficient is taken to restore a measure 
of activity ; then, tired and worn, they renew their efforts to finish the 
toilsome work forced upon them. 

Nature has generously anticipated human irregularities and caprices. 
She endows the organs of man with powers greatly in excess of what they 
will need to do her bidding, she provides for his unwarrantable inter- 
ference. Day after day the stomach is pushed to fatigue, still its wondrous 
vitality seems unimpaired. There is a limit, however, to all this, and at last 
restoration and reaction after overwork are not complete ; disease then soon 
follows functional enfeeblement. 

It is a duty each owes himself to so regulate his diet, digestion will not 
be taxed beyond the limit of easy performance. If one has been accus- 
tomed to meats in excess, and feels that denial in quantity would be too 
great a hardship, he certainly can do no less than substitute flesh of easy 
digestion, for that which he well knows imposes heavily on his stomach. 

If the American people, who as a nation are noted for their meat- 
eating propensities, were to more largely subsist upon fish, better health 



1 I FOOD. 

would be by them enjoyed, and much longer life promoted. The appetite 
would be as well satisfied, nutrition be fully sustained, and disease less 
prevalent. 

The fact that the flesh of fish is comparatively free from stimulating 
properties enhances its value as food, and while an exeessive indulgence in 
meat unquestionably tends to diminish intellectual activity, a diet of fish 
undeniably contributes to mental vigor. 

Fish very rapidly undergo decomposition, and, as is the case with meats, 
are changed by the preservative processes. Salting, pickling, and smoking 
renders the flesh tougher and less digestible. 

The effect of salted meat and fish upon the system is largely deter- 
mined by the other ingredients of the diet. If a reasonable quantity of 
vegetable substances be daily consumed, evil results are much longer delayed. 
It has been stated, by those who have had opportunities to verify the fact, 
that if on shipboard the crews have dry and w r ell aired quarters, comfort- 
able bedding and clothing, there is great probability of their being exempt 
from scurvy, even though their food should be, as far as relates to the 
animal portion of it, entirely of salt meat. If they are jDrovided with fresh 
water in abundance, biscuit of good quality, and the customary allowance 
of beans and peas, with molasses and vinegar, it is said that sailors may 
eat daily for a twelvemonth of salt beef or salt fish without suffering 
from scurvy, provided all the other conditions mentioned are complied 
with. 

The dyspeptic symptoms which are commonly complained of by those 
who eat much of salted and smoked meats and fish, can often be attributed 
to the excessive quantity indulged in, and also to the fact that vegetables 
do not sufficiently enter into the diet. It is assumed that among laborers 
will be found many limited by their means not only to the coarsest, but to 
the cheapest articles of food. Necessity certainly knows no law, but 
voluntarily people should eat very sparingly indeed of salted or smoked 
meats or fish. 

As soon as the putrefactive changes commence, fish are at once rendered 
unfit for food; in providing for the table, it is necessary to be extremely 
cautious, and accept only those absolutely fresh and untainted. There are 
certain species of fish known to possess properties poisonous to all. It has 
not as yet been determined to what elements the noxious effects should 
be ascribed. 

Some people have decided antipathies to fish of all varieties, and none 
can be eaten by them without unpleasant symptoms being manifested ; 
others are injuriously affected only by certain species. The symptoms 
occasionally produced are somewhat similar to those in cholera, — severe 
abdominal pain, vomiting, diarrhoea, and great prostration, if not collapse. 
In some the nervous system is principally affected, and trembling or 
twitching of the limbs is noticed ; paralysis and stupor have been know T n 






DR. DAVY ON FISH. 1 .', 

to follow the eating of fish. More often the noxious effects are manifested 
by an eruption resembling nettle-rash. 

It is not unreasonable to suppose that from the food on which fish 
subsist, may be acquired some of the properties which characterize the 
poisonous species. If long kept without being subjected to preservative 
processes, it would not be unreasonable to ascribe the noxious agency to 
putrefaction. It is recognized as a fact, that some persons possess pecu- 
liarities of constitution and susceptibilities which render it impossible for 
them to eat certain fish, when the same may be freely and safely indulged 
in as food by others. 

Regarding the edible qualities of fish, Dr. Davy says: "As to indi- 
vidual species, whether of sea fish or fresh-water, there are notable differ- 
ences and peculiarities, some depending on the species, some on the 
qualities of the feed. Of the first we have instances almost without 
number, inasmuch as almost each, kind has some distinctive peculiarity. 
The delicate smelt has the odor of the cucumber; the grayling, of the 
thyme ; some of those of the scomber family abound in blood, have a com- 
paratively high temperature, and dark-colored muscles ; others, as those of 
the Galidse, of which group the whiting is one, have little blood,— -at least 
few red corpuscles, — have white muscles, and are delicately tasted; some, 
as the common ray, and most of the order of cartilaginous fish, have a 
muscular fibre of much firmness and power of resistance, yielding and 
becoming tender from keeping, and consequently, contrary to the general 
rule applicable to fish, they should not be dressed fresh; and other differ- 
ences might be pointed out, — one kind abounding in oil, as the pilchard, 
herring, and the eel, the eel especially, and so luscious in consequence; 
other kinds containing little or no oil, as the sole and ray. 

"Of the influence of feed on the same kind of fish we have striking 
examples, both in many salt-water and fresh-water species. Of the former, 
how T different in quality is the herring caught off different parts of the coast ; 
so, too, of the common haddock. What herring is equal to that of Loch 
Fine; what haddock equal to that of the Bay of Dublin? Of fresh-water 
fish, what a contrast there is between the lake trout and brook trout ! the 
one well fed, well flavored, of the color of the salmon; the other small, 
colorless, and insipid. What a contrast between either of these and the 
trout of bog-w*ater; the latter black, soft, ill-formed, and ill-tasted. What 
a contrast, again, between the trout inhabiting a stream in a fertile lime- 
stone district, fed by springs, fluctuating little, and the indwellers of tin 1 
mountain stream of a primitive country, subject to great fluctuations, — one 
day a raging torrent, in a brief space run out and all but dried up. As witli 
other animals, whether beast or bird, domestic or wild, much, we know, 
as to their quality, depends on their feed, its kind and quantity, and so with 
fish. Of these the paradoxical sturgeon may be mentioned as another and 
very striking example ; by the Norwegians, we are informed by Block, it is 



OD. 

g ! ted after the fish on which, from its flavor, it is sap] sed 1 

3 the mackei -starg rring-eturgeon, etc. 

ther circumstances bee b! . qo doubt, have likewise an effect — 

all which anywise influence the health, such as climate, air. water, etc. : nor 

amongst these should _ knitted. This last, in the instance of fish. 

and of fish only, is little thought oi at home : and it may be because, hi 

our welL-fished seas, rivers, and lakes, few fish are allowed to reach a very 

advanced aire: but not so in the tropical seas, where there is not the same 

ity practised in the capture of fish: there it is not uncommon to be 

•d at table to an old fish, and to have its hardness and toughness 

explained by one's experienced host by reference to ag 

caught from ponds, ditches, and standing waters, are certainly less 
wholesome than those from rivers or lakes, where the natural element is 
purer, and the food afforded them is of an entirely different an 
character. The quality of river fish is also found inferior when caught 
near towns and cities through which the streams flow, and from which they 
e impurities. 
By many, salt-water fish are, as a whole, preferred. It is claimed that 
their flesh is firmer, more agreeable to the taste, and less rapidly attacked 
ntrefactive chaug es 
The flesh of some fish is white, and that of others more or less reddish. 
The former is less stimulating, contains a smaller amount of fat, and 
is more easy of digestion. The proportion of oily matters, to - 

tain extent, influences the value of the flesh as food, for the fat of fishes 
taxes the stomach more y than that found in meats. This fact sug- 

_ sts that when the richer varieties of fish are eaten, other dishes, such is 
acid sauces and pickles, should be in small quantities partaken of. as by 
their use digestion is facilitated. If the flesh is fried, fat being used in the 
process, then admitted to the stomach there to mingle with, butter, also 
freely indulged in. the result is an admixture of three animal oils. Con- 
sidering the habits of many people, and their melhods of cooking, it is not 
at all surprising that they find fish difficult of digestion. 

Amongst the fish having white flesh are, the whiting, halibut, 
haddock, sol-, turbot, brill, plaice, flounder, etc. Very little fat exists in 
these, excepting in the livers, that of the cod especially at certain seasons 
being heavily loaded with it. The salmon, eel, mackerel, herring sprat, 
pilchard, may be mentioned among the fish in the flesh of which fatty 
matter exists in a considerable quantity. The salmon is especially rich in 
this constituent, the fat be: _ sited in the tissues; also a layer of it is 

found beneath the skin. In the composition of eels a still greater amount 
Qy matters exists : in consequence they are exceedingly rich, and nn- 
suited to delicate stomachs. In a general way. it may be said, that in the 
liferent species of fish in which fat abounds, the :_ as 
concerned are taxed in proportion to the quantity present. 



FISH AS FOOD. 17 

Of all fish, the whiting yields flesh the most tender and digestible. The 
cod and haddock are among the most plentiful white-flesh fish; the former 

is mneli preferred as an article of food, although the latter is said to In- 
more easy of digestion. The halibut is a fish of fine flavor, held in greater 
esteem by the general public than either of the two mentioned. More tat 
is present in its tissues, deposited in greater abundance near the fins. The 
sole is a fish of delicate flavor; it is tender, easy of digestion, and a valu- 
able article of food for invalids. 

The turbot and brill are esteemed as luxuries on account of their rich 
flavor. The former is much superior in delicacy and texture. Both are 
less digestible than other kinds of flat fish, such as the sole, plaice, and 
flounder. This fact has been attributed to the richness of their skins, 
which are eaten as dainty morsels. The flounder, while light and easily 
borne on the stomach, is not popular as an article of food, by reason of its 
want of any distinct flavor. 

The smelt is a small fish resembling much the trout in form. When 
recently caught, it has the odor of cucumber. The flesh is much esteemed 
as food, being of very rich flavor. The common process of cooking is by 
frying; therefore it cannot be recommended to those unfortunates in whom 
dyspeptic symptoms are easily excited. 

Among the choicest delicacies esteemed by epicures is whitebait, a fish 
both rare and expensive. These delicious mites are usually fried in fat, 
and the process naturally renders them somewhat difficult of digestion ; 
for that reason the juice of lemon should be used to lend aid to the 
stomach. 

Very many varieties of fish other than those mentioned serve the pur- 
poses of food. In different countries the inhabitants are supplied with 
species common to them. The sturgeon, seal, shark, and even portions 
of the whale, are eaten, and deemed delicacies, by certain races of 
people. 

The quality of fish, as is the case with game, changes at certain periods 
of the year. It is best just previous to spawning, and then the term "in 
season" is applied. Fish at this time are in a plump condition, and the 
flesh is of a richer flavor ; when " out of season " they are thin, flabby, 
and unfit for food. 

Among the animals having the power of living in both air and water, 
some yield flesh esteemed by man as articles of food. Frogs are highly 
prized by epicures for their hind legs ; other parts are rarely eaten except 
by the Chinese. The marine turtle furnishes the ingredient from which 
choicest soups are made. The Iguana, found in South America and the 
West Indies, is a species of lizard of a most forbidding aspect, yet its 
flesh is deemed a great delicacy. 



18 FOOD. 



SHELL-FISH. 

While shell-fish yield food less nutritious than the species described in 
the foregoing, they are by no moans unimportant constituents of the diet 
ot* man. Of the so-called crustacean tribes of fish, the lobster, crab, craw- 
fish, shrimp, prawn, are commonly oaten; the first named is by far the 
most in favor with the people. 

The tlosli of the lobster is white, and possesses a peculiar and agreeable 
flavor. While it alone is difficult of digestion, the use of the condiments 
pepper and vinegar, so aid in the process, the tax upon the stomach is 
rendered loss severe. On some persons, peculiarly constituted, lobsters 
have a decidedly unpleasant, if not poisonous, effect, producing an erup- 
tion and other distressing symptoms. What may be termed fish antipathy 
is probably more often excited by this species than any other. 

The most delicate and digestible flesh of the lobster is found in the 
claws and tail. In the female the spawn or eggs and so-called coral are in 
- scial demand, the former for sauce, and the latter for garnishing. 
After being removed from the shell, the fiesh is sometimes submitted to 
other processes of cooking, which generally tend to render it still more 
difficult of digestion. In Germany, and other parts of the Continent, the 
lake and river lobsters are commonly boiled alive in milk. This consti- 
tutes quite a popular dish ; still, so incongruous a mixture cannot be ap- 
proved. 

The flesh of the crab somewhat resembles that of the lobster, but has 
a less delicate flavor, and is more of a burden to the digestive organs. 
That found in the claws is more easily digested than the soft mass 
inclosed in the shell, which consists principally of liver. From the fact 
that both lobsters and crabs are difficult of digestion, convalescents and 
others in whom dyspeptic symptoms are easily induced, should be denied 
them. 

Crawfish are found both in the sea and in rivers. The sea crawfish is 
of the nature of lobster, but of much less value as an article of food, the 
flesh being coarser and inferior in flavor. The fresh-water crawfish yields 
flesh more tender and easy of digestion than the lobster. From its size, it 
is not depended upon for the amount of nutritious matter it furnishes, but 
is used in soups and dressings. 

Shrimps and prawns are of the same family, and allied to the lobster, 
which they excel in digestibility. They are very generally esteemed as 
articles of food, but are not to be recommended to those in whom the di- 
gestive organs are weak and inactive. 

Of the shell-fish belonging to the molluscous tribe, popular as food in 
this country, the oyster takes precedence. Mussels are eaten, but far less 
often, and scallops, cookies, periwinkles, limpets, and whelks, are only 
occasionally indulged in. 



OYSTERS VISCERA. l'.i 

The cultivation of oysters has, within a few years, grown to be an 
industry of vast proportions, testifying to the fact that they are highly 
prized as food by the American people. They abound in nutritive proper- 
ties, and in their natural state are readily digested even by delicate 
stomachs. When raw, they are in every respect preferable; for by cook- 
ing they are deprived of certain elements, and acquire others which render 
them difficult of digestion. 

The fact that in their natural state oysters are swallowed without mas- 
tication, is of less importance, as their jelly-like substance is easily sepa- 
rated by the action of the stomach. The salt water which they contain, 
is an agency which assists somewhat in their solution. All the processes 
of cooking render them more solid, hard, and indigestible ; when fried, 
they tax the digestive organs severely. 

The old saying that oysters are good only when there is an " r " in the 
name of the month, has a foundation of truth. In the month of May they 
cast their spawn, and, as is the case with all fish after that operation, they 
are thin and weakly. During the next two months they steadily improve, 
and in August become fat and plump again. 

Mussels, of all shell-fish, have the least virtue to recommend them as 
food. Ordinary processes of cooking render them tough, leathery, and 
indigestible. By prolonged baking in a sealed oven they are softened, and 
become more eatable, but the needed conveniences are possessed but by 
few cooks. Generally, they are first boiled, and afterwards submitted to 
other methods of cooking, by which means, if prolonged, they may be 
partially dissolved, and more easily acted upon by the digestive fluids. To 
no other shell-fish have so many cases of poisoning been ascribed, as to 
mussels. Considering this fact, and their tax upon digestion, they have 
little left to recommend them as food. 

The small shell-fish are but seldom eaten in this country. In England 
they are popular among certain classes, and venders of them are common 
sights in the streets of London. 



VISCERA. 

Liver. Of the internal organs of animals the liver is the most largely 
consumed by man. Not only its richness, but also the manner in which it 
is usually cooked, render it difficult of digestion. It has a laxative action, 
doubtless due to its indigestibility, rather than to any inherent property. 
The great luxury, "foie gras" is the liver of the goose, enormously en- 
larged and loaded with fat. To produce this condition, geese are subje< ted 
to confinement in small wooden coops, large enough to admit them, but in 
which it is impossible for them to turn around. For about three weeks, 
maize, or Indian corn, previously soaked in water, is crammed down the 
bird's throat morning and night. As a result of this process, the livers 



FOOD. 

enlarge rapidly, and finally weigh from one to two pounds. Of their com- 
position, tat constitutes more than one-half of all the elements. 

ley. [f rightly cooked, the kidney is soft and of agreeable flavor; 
it long exposed to great heat, the substance contracts and becomes dry, 
tough and tasteless. Stewing them in their own vapor is the more 
common custom oi experienced cooks; by this means they are rendered 
less indigestible. 

7'rijn . i The paunch of the ox is quite easily acted upon by the stomach, 
it properly served. As tripe is rich in fat, broiling would be preferable to 
frying. The pickling process to which it is often subjected, renders it 
more easy o\ digestion. 

s thread is a somewhat indefinite term, as it embraces more than one 
organ. The so-called stomach sweetbread is the pancreas, and the throat 
Bweetbread is the thymus, a gland of the throat. The brain is the sweet- 
bread of young calf. When richly dressed, it severely taxes the stomach ; 
when plainly cooked, it is very digestible. 



EGGS. 

"While various eggs are eaten, including those of reptiles, such as the 
turtle, the eggs of the fowl are justly preferred, and more generally 
employed as articles of food. Eggs contain all the elements needed to 
sustain nutrition, but if they alone were depended upon, the large number 
necessary to supply one important nutritive principle would overload the 
system with other elements. 

The white of eggs in its natural state is soon absorbed after entering 
the stomach, the gastric juice changing it but slightly. The yolk contains 
some thirty per cent of fatty matter, and the nourishing j^roperties are 
therefore much greater in that than in the white. 

Egos in a raw state, or lightly boiled, are easy of digestion ; still, many 
] persons complain that wdien they indulge in them dyspeptic symptoms are 
<ure to follow. The most common reason of this is, eggs change very 
quickly, and should only be eaten while fresh. Again, considering the great 
proportion of fat contained in the yolk, when eggs are eaten other fatty 
foods should not be indulged in at the same meal. Salt should also be 
used quite freely with eggs, as it promotes their digestion. If hard-boiled, 
they resist the digestive fluids, and tend to decrease the activity of the 
bowels. Eggs of ducks and geese are rank in taste, dry and indigestible. 
The roe is the seed or spawn of fish ; caviare is the hard roe of the female 
sturgeon, preserved by salting; cod sounds are the swimming-bladders of 
that fish. Caviare is a common food in Russia, but a luxury in America. 
Sounds are very rich, and, as with other articles of food of a similar 
nature, would be more digestible but for the change they undergo in salt- 
ing, pickling, etc. 



MILK. 2 1 



MILK. 



In milk are found embodied all the nutritive elements required for the 
growth and maintenance of the body. Upon it alone nature has ordained 
that the young of a certain class of animals should for a definite period 
subsist. 

The principal ingredients of milk are casein, fatty matter, lactin, or 
sugar of milk, mineral salts, and water. The casein constitutes the curd, 
and is the basis of cheese. The fatty matter constitutes butter; the lactin 
is one of the varieties of sugar. The mineral salts and water are elements 
derived mostly from the exterior, for which reason they are termed inor- 
ganic principles. 

The proportion of the several constituents of milk varies, not only in 
different animals, but in the same animal at different periods. The follow- 
ing table gives the composition of milk from three sources : — 

Woman's Cow's Goat's 

Water 890 858 868 

Butter 25 38 33 

Casein 35 68 40 

Sugars and extracts 48 30 53 

Salts 2 6 6 

Milk begins to turn sour after a time, depending principally on the tem- 
perature, owing to the formation of lactic acid by a process of fermenta- 
tion at the expense of the milk sugar. The acid so developed causes the 
coagulation of the casein, and the milk separates into a solid white curd 
and a thin transparent fluid called whey. Warmth favors this change, and 
contact with a small body of milk which has become sour, will also rapidly 
curdle the entire bulk so exposed. Dairymen have learned from experience 
that perfect cleanliness of their vessels and cans is one of the most impor- 
tant essentials in the preservation of their milk. 

When milk has been carefully and uniformly cooled by ice water*, and 
remains in it protected from change in temperature, it is said to continue 
sweet and unaltered for fourteen days ; after that time it acquires a rancid 
taste. If the same milk is allowed to remain until the twenty-eighth day, 
it will then on boiling coagulate, owing to the presence of an acid result- 
ing from oxidation of the cream. On the thirty-fourth day it coagulates 
even in ice water. 

The keeping properties of milk are said to be much improved by aera- 
tion, effected by allowing it to pass through the meshes of a sieve and fall 
from a height in a state of fine division. Boiling is one of the prescrv.it i\ e 
processes, air, the chief element of fermentation, being eliminated ; but the 
smell, taste and other properties are affected, partly owing to the escape of 
gases mingled with the milk when fresh. The unpleasant flavor communi- 



22 FOOD. 

cated by boiling can be avoided if a closed vessel is used, and the milk 
immediately cooled in iee water. 

It there is any suspicion oi taint in the milk, either from disease of the 

. contamination from unhealthy or unclean persons, or the use of in- 
fected water in cleaning the vessels, boiling is advised, as it effectually 
destroys the germs of disease, in the carrying and spreading of which milk 
is a most active agent. 

Cold is the most effectual and the least objectionable of preservatives, 
but all systems in use have serious disadvantages ; either they serve the 
purpose but for too limited a time, or interfere with the natural constitu- 
tion and properties of the milk. 

Chemical agents are too often resorted to by dairymen ; salycilic and 
boracic acids are those most commonly employed. By their use in small 
quantities, milk is kept unchanged for a longer time, but while they may 
do little or no harm, good judgment remonstrates against their use. 

It is believed that thus far, no two chemists have been known to agree 
in their analyses of milk. This is doubtless due to the fact that animals 
vary at different times, influenced by many circumstances. As the food 
and drinking water is changed in character or quantity, the fact is registered 
by the milk. In woman, mental disquietude, and in the lower animals fear, 
violent exercise, and abusive treatment, are all followed by changes in their 
secretion. Again, there is a marked difference in the quality of milk at 
the beginning and end of milking. The cream seems to rise while 
within the gland of the animal, and the last milk drawn is much richer in 
this constituent. There is a vast difference in the properties of milk 
yielded by different breeds; that of the Alderney is rich in fat, while that 
from the long-horn contains a larger proportion of casein. 

With these many variations in milk, it is not surprising that analyses 
also vary. As an accepted fact, that of the cow is the nearest approach to 
that of woman ; the former contains an excess of the solid constituents. 
The next which follows is the goat's; the milk of other animals it is un- 
necessary to consider, excepting it be that of the mare. 

Koumiss is properly a fermented drink, prepared from mare's milk by 
the Tartar tribes of the Russian empire, and all the nomad races of the 
northern part of Asia. It is made by diluting mare's milk with about one- 
sixth part of its quantity of water, and adding as a ferment about one- 
eighth part of sour milk or old koumiss. This mixture is placed in a 
wooden vessel which is covered over with a thick cloth, and so left for 
about twenty-four hours in a moderately warm temperature. A thick 
coagalum rises during that time, which is re-incorporated by churning. 
After standing for another day the whole mass is again churned and mixed 
up, and in this state it forms new koumiss, having an agreeable, slightly 
acid taste. The liquor is then preserved in skin bottles, in which fermen- 
tation continues developing alcoholic qualities, and mellowing and improv- 
ing its taste. 



KOUMISS. 23 

In making it the simplest of the directions is as follows: Fill a quart 
champagne bottle up to the nock with pure, fresh milk; add two table- 
spoonfuls of white sugar, after dissolving the same in a little water over a 
hot fire; add also a quarter of a two-cent cake of fresh compressed yeasl ; 
then tie the cork on the bottle securely, and shake the mixture well. Place 
in a room of the temperature of 50° F. to 95° F. for six hours, and finally 
in the ice-box over night. Drink in such quantities as the stomach may 
require. This, as will be seen, is very inexpensive. Care should be taken 
not to allow it to be used if it contains curds, which indicate too much 
fermentation; precaution should be observed in opening the bottle, on 
account of the effervescent quality of the product. Some observers recom- 
mend a dilution of the milk with water, varying from one seventh to one 
half, before the fermentation. 

Probably koumiss has no essential virtues other than those which 
resided in the original milk, and which are preserved by the processes to 
which it is submitted. It is a drink easily borne on delicate stomachs, and 
is a very agreeable change to some invalids long confined to a liquid 
diet. 

Mothers nursing their infants are taught to practise self-denial in eat- 
ing and drinking ; fruit and green vegetables, or any substance containing 
an acid, are forbidden them. This is certainly right and proper, but at the 
same time they should not be confined to animal food. A diet of vege- 
tables in season affords a greater quantity of milk, and of a better quality, 
than one largely made up of meat. Any substance eaten by them which 
produces abdominal pain and diarrhoea, will induce similar symptoms in 
the child. It therefore becomes them to carefully watch their own di- 
gestive organs, and maintain them in a healthy state. Very often mothers 
will complain that their infants are frequently attacked with colic, and 
wonder at the cause. At the same time they themselves are suffering from 
aggravated dyspepsia. 

Milk is one of the most valuable articles of diet in all conditions of 
health, and no other can supply its place in the sick-room. It is true that 
occasionally will be found persons who will complain that it disagrees with 
them, but in such cases there are, almost always, disordered conditions 
which are influential, or to which the cause can be assigned. The stomach 
may become weakened by abuses or disease, and milk be rejected or induce 
aggravated dyspeptic symptoms ; at such times the digestive fluids seem 
changed in their integrity, and incapable of proper action. The presence 
of the acid constituents in excess, often demands the addition of lime- 
water to the milk to neutralize them. 

It is the popular prejudice that if milk is rejected in a curdled state, it 
is indisputable evidence of its unfitness at that time as an article of food. 
Physicians hear this complaint so often, they grow tired of attempting to 
educate their patients to a knowledge of the simple physiological law 



24 l\ >0D. 

that milk must always be coagulated by the gastric juice, while the process 
of digestion is going on. 

The most common reason why milk is not well borne, is due to the fact 
that people generally drink it too quickly. It a glass of it is swallowed 
hastily, it enters the stomach and there forms in one solid curdled mass, 
difficult of digestion. If. on the other hand, the same quantity is sipped, 
and three minutes, at least, is occupied in drinking it, then, on reaching the 
stomach, it is so divided that, when coagulated, instead of being in one 
hard, condensed mass, upon .the outside of which only the digestive fluids 
can act. it is more in the form of sponge, and in and out of the entire bulk 
the gastric juice can freely play and perform its function. 

Milk may be rendered more digestible, and, for many, of a more agree- 
able taste, if prepared by slowly adding to it until curdled dilute hydro- 
chloric acid, drop by drop, while warm, stirring it at the same time. By 
this means the curd is broken up, and is in a more favorable state to be 
acted upon by the digestive fluids. 

Before leaving this subject, the writer feels impelled to add a few lines 
on infant feeding, merely touching on some of the most important features. 
Nature ordained the mother's milk food for the child. Fashion often, and 
physical derangements rarely, consigns the infant to artificial nourishment. 
Cow's milk is selected, and with the manner of using it properly few are 
familiar. The diverse theories of physicians may, in a measure, be 
accountable for this state. Some contend that the milk of the cow should 
be diluted during the entire period it is given ; others advise that water 
should not be added after the first few weeks of life. Mothers cannot 
properly accept of either theory at the exclusion of the other; they must 
study the condition of their children, and then judge for themselves which 
is the proper course to pursue. 

The food of a new-born infant decreed to live on cow's milk, should be 
at fir.^t diluted with three parts water. After a few weeks, a larger pro- 
portion of milk is allowable ; how great an increase, a study of the child's 
digestion ought to determine. Milk which does not digest will not nour- 
ish ; on the contrary, it irritates, and, as is the case with other undigested 
food, one can starve, with a stomach full of it. Diarrhoea and colicky pains 
in artificially fed infants, are very often evidences of the indigestibility of 
the food which they are taking, and they call for greater dilution. 

It would be well for mothers to study the effects of two methods of 
feeding ; the one of water and milk, the other a diet of pure cow's milk. 
Both have advantages, and on one or the other a child should be well 
nourished. If pure milk is user], it must be only in very small quantities; 
if water is allowed at all, it can be given separately when the child 
appeai-s thirsty. This practice recommends itself, and is in keeping with 
the dietetic law, that the digestibility of food largely depends upon its 
concentration. 



INFANT FEEDING. 25 

The habit which many mothers have of feeding their children at the 
table, and on other food than milk, after the fifth or sixth month of life, is 
most pernicious, and one to which the death of countless children can be 
attributed. There is no sense or reason in such a custom, and those who 
thus outrage Nature's laws, must feel that when punishment is meted out 
to them, it is justly merited. 

Until a child has sixteen teeth through the gum, its diet should be 
liquid only. In the last few months before that period is readied, thin 
gruels, broths, or whites of eggs, may be allowed with the milk, but solid 
food never, for by it digestion is disturbed, and the child forced to run the 
gauntlet of cholera infantum, dysentery, and convulsions. 

After this brief and rambling discussion of infant's feeding, the impor- 
tance of the subject may be condensed into a few words. For the first 
eight or nine months, milk is the only food allowable. From this period 
to the eighteenth month, the diet should be liquid and easy of digestion. 
If mothers will observe this rule, ignoring the interference of those antique 
advisers who in their conceit consider themselves as entirely exempt from 
liability to mistake, then, and not until then, will disease and death in their 
homes be no longer invited guests. 



BUTTER. 

Butter is the fatty matter of milk, obtained by churning. Formerly 
only the cream was submitted to this process, but recent inventions allow 
the fat to be extracted from milk by machinery, without any preparatory 
delay. In the composition of the pure fatty matter of butter, there are 
six fatty principles; an extended consideration of them Avould be unin- 
teresting, and of no value to the reader. 

Butter, when fresh and sweet, is a valuable article of food, if used with- 
in certain limits. It not only supplies to the system heat-producing ele- 
ments, but renders other food more palatable. The unattractive character 
of dry bread, as an article of food, is compensated for by the relish of a 
savory addition. If a person was to depend upon it entirely, at least four 
pounds of bread each day would be needed to furnish sufficient nutriment. 
In proportion as the use of butter is increased, the requisite amount of 
bread may be decreased. 

Church says : " Fat butter and oily matter in general require no diges- 
tion ; the emulsion into which they are mechanically converted, chiefly by 
the pancreatic and duodenal secretions, passes (almost directly) into the 
general circulation of the blood." It is well known that those people 
who may be termed "indifferent eaters" generally indulge sparingly in 
fatty matter, and for that reason cream and butter are important essen- 
tials in their diet. 

The value of butter as an article of food, depends much on the quantity 



V. FOOD. 

of animal substances taken at the same meal. When oaten freely with 
meats, other fatty matters accumulate within the stomach, and digestion is 
thereby retarded. Butter is with some difficulty incorporated with the 
ingredients of which pastry is composed, and the cooking which follows 
renders it still more indigestible. 

Butter, when fresh and unchanged, is a wholesome constituent of man's 
diet; by the action of heat it becomes indigestible and invites dyspepsia. 
Fried food is rendered doubly burdensome to the stomach if this agent is 
used in its preparation. It is believed that the American people generally 
not only use too much batter, but also unwisely employ it in cooking. 
V. re -ilt more often substituted for it, dyspepsia would be less common, 
and more perfect health enjoyed. 

CHEESE. 

Cheese consists principally of the casein of milk ; it is the curd sepa- 
rated from the whey and rendered hard by pressure. Butter is present in 
varying amount, according to the manner in which it has been prepared, 
and upon the fatty matter the quality of cheese depends. Among the 
richest cheeses are the Stilton and double Gloucester, and in their manu- 
facture cream is added to the milk; in the single Gloucester, Chester, and 
American, part of the cream is removed. Cheshire cheese is made from 
unskimmed milk; the Dutch, Parmesan, Suffolk, and Somersetshire, from 
skimmed milk. Cream cheese is the fresh curd subjected to only a slight 
pressure. 

The Parmesan cheese, so called from Parma, Italy, where it is manu- 
factured, owes its rich flavor to the fine herbage of the meadows along the 
Po, where the cows are fed. The best quality of this cheese is kept for 
three or four years, and none is ever carried to market until it is at least 
six months old. 

The Swiss cheese, particularly that denominated Gruyere, from the 
bailiwick of that name in the canton of Fribourg, is very celebrated. This 
chee<e is made from skimmed milk, and is flavored with herbs. France is 
noted for its cheeses, among which are the Neufchatel, the Sassenage, the 
Roquefort, and the Griese. Among the Genoese, cheese is made from 
ewe's milk; the Laplanders use for the same purpose the milk of the rein- 
deer. 

While the fatty matter gives softness and richness to cheese, it is the 
agent which invites decay on keeping. Cheese made from skimmed milk, 
deprived of this ingredient, keeps the best, growing hard and dry with 
age. 

There is hardly an article of food on the dietetic value of which so 
many diverse opinions have been expressed. Some have complained of its 
indigestibility, while many among the poorer classes have eaten largely of 



CHEESE-POISONING. 27 

cheese, and from it derived much of their nourishment; the latter have 
rarely found it a tax upon digestion. A person, after indulging freely 

in boiled, roast, or fried meats, and other substances which constitute a 
hearty meal, cannot expect his stomach to bear patiently the additional 
burden of a substance so rich in animal nutriment. Let the laboring man 
breakfast or dine on bread and cheese, and he will have small cause for 
complaint. 

As is the case with many other articles of food, when reason controls 
its use, cheese is of considerable dietetic value. When properly made, 
long kept, and well ripened, it is not only well borne, but, if taken in a 
small quantity, it aids the digestion of other food, by a stimulant action on 
the stomach. By it the unpleasant effects of fruit are often obviated. 

The rich cheese, easily crumbled and of strong flavor, is the most 
digestible; the hard horny varieties made from skimmed milk are a burden 
to the stomach. Toasted cheese should never be indulged in ; it is one of 
the most indigestible substances which can be eaten. 

Cheese is liable to develop poisonous properties by undergoing a form 
of decay. In 1884 there occurred in Michigan four outbreaks of cheese- 
poisoning, during the months of May and June. These were confined to 
four small towns adjoining each other. All of the persons who ate of the 
cheese in question, about one hundred and sixty-four in all, were taken sick 
with the same symptoms, namely, pain and a burning sensation in the 
stomach, intense vomiting and purging, feebleness of the pulse, coldness 
of the extremities, and a tendency to collapse. All finally recovered. The 
cheeses were ordinarily good-looking specimens, but, when they were cut 
or broken, a liquid oozed into the pores. In each case the cheese was 
made at a factory in Fruitridge, Lenawee County. 

Dr. V. C. Vaughan read a report on the subject before the State Board 
of Health. At the request of the Secretary, he had visited the factory in 
Fruitridge, and had analyzed specimens of the cheese. Everything about 
the factory had appeared to be scrupulously clean, and nothing in the vats, 
the cans, or the surroundings offered an explanation of the cause of the 
poisoning. Analysis showed no arsenic, copper, lead, iron, or other mineral 
poison. When the cheese was cut or broken, a whitish liquid oozed into 
the pores, and in this liquid microscopic organisms were detected. The 
liquid was very strongly acid. For more than a hundred years, the report 
continued, the attention of the scientific world had been drawn to the sub- 
ject of cheese-poisoning, by repeated outbreaks of this sort, both in this 
country and in Europe. Much had been written on the subject, and many 
investigations had been carried on, especially in Germany. By various 
observers the poisoning had been ascribed to diseased milk, decomposition, 
and the development of certain fatty acids, etc. ; but we did not yet know 
what made the cheese poisonous. In regard to the cases under considera- 
tion, the maker of the cheese had stated that the cheese which had pro- 



: 8 FOOD. 

duced the bad results had all boon made between the 2Ctli of April and 
the 26th of May, in the same manner and with the same care as other lots 
which had given no cause for complaint. Good choose was only very 
- ..ily acid, and was slow in reddening blue litmus paper; but the poison- 
S fl as intensely acid, a freshly cut surface of it reddening litmus 
paper instantaneously. This test for poisonous cheese appeared to be prac- 
tical, as the litmus paper could be applied by any grocer to a freshly cut 
surface of the cheese. If it was instantly turned red by the liquid which 
oozed into the pores, the cheese was to be suspected of being poisonous. 



CEREAL GRAINS. 

Oi vegetable food, cereal grains rank first in importance. Many varie- 
ties exist, all agreeing in general composition, but differing in the relative 
amount of nutritious principles. It is essential in this work to consider 
only those grains and their products which most commonly enter into the 
diet of man. 

WHEAT. 

Wheat is the most important vegetable substance used as food. It is 
very rarely eaten in its entire state, but is prepared by grinding, and after- 
wards subjected to the process of "bolting." By these operations the 
grain is converted into flour, from which the bran is removed. "Wheat, in 
its natural state, is enveloped in a thick horny covering, so firmly coherent, 
that it presents itself under the form of scales when submitted to the 
operation of grinding. This enveloping substance constitutes the greater 
bulk of bran, and, while it is rich in nutritive elements, it is valueless as 
food, by reason of its indigestibility. Sometimes it is retained with the 
flour, and eaten by persons affected with constipation ; in such cases the 
bran acts mechanically, by irritating the digestive organs. 

Among other important constituents, wheat contains one upon which 
the easy conversion of flour into articles of food largely depends. A mix- 
ture of flour and water makes dough, the tenacity of which is due to this 
itial agent, gluten. Sugar is sometimes a constituent of wheaten flour, 
and it is as often absent. Its presence depends upon the harvesting, grind- 
ing, and keeping of the wheat and flour, and the chemical changes which 
take place in certain constituent principles. 

After wheat is ground and bolted, it is submitted to the so-called 
"dressing." Ily this process the coarser particles are separated from the 
flour, and the finer it is dressed the whiter the bread it produces. To 
please the eye, however, the virtues of the flour must be sacrificed, as the 
coarser it is the more it abounds in nutritive elements. 

Bread. Of all articles of food prepared from vegetable substances, 
bread is the most important. It is rich in principles necessary to nourish 



BREAD. 29 

the body, and when properly made is readily acted upon by the digestive 
fluids. The distinguishing features of good bread are its lightness and 
sponginess ; upon these conditions the facility with which it is digested 
depends. 

Bread is "raised" by fermentation, the yeast acting on the starch of 
the flour and causing the generation of carbonic acid gas. This gas is 
diffused throughout the dough in preparation, and converts it into a porous, 
spongy mass. Baking causes four changes: (1) expands the gases, and 
lightens by exhausting the moisture; (2) stops fermentation ; (3) drives 
away the alcohol; (4) changes starch on external crust into sugar. Heat 
by its. action on the constituents of flour also renders bread digestible. 

" Baking powders " are used in making bread to save the starch and 
dispense with fermentation. By their use, carbonic acid gas is generated 
in the dough, and all the constituents of the flour are saved. 

"Aerated bread" is made from flour and water, impregnated with 
carbonic acid gas under a high pressure. It represents the purest form of 
bread, as its composition is the simplest, and can be kept unchanged for a 
considerable time ; still, in taste it lacks the agreeable flavor which charac- 
terizes the fermented kind. 

The best flavored bread is made by fermentation, and only that in 
which yeast has been employed possesses the pleasing taste so charac- 
teristic. Of the varieties of ferments, the brewer's yeast is said to com- 
municate the highest flavor. 

Alum is an agent which has been much used, in times past, to improve 
the appearance of bread made from an inferior quality of flour. The very 
purpose of its use condemns it, and while it might not be considered 
positively injurious in some cases, in others it would prove a noxious 
agent. Pereira says, "Whatever doubts may be entertained regarding the 
ill effects of alum on the healthy stomach, none can exist as to its injurious 
influence in cases of dyspepsia." 

Stale bread, firm and easily crumbled, is the most digestible ; that 
recently made is soft, and forms in a close, heavy mass in the stomach. If 
old loaves are objectionable on account of taste, they can be rebaked and the 
fresh flavor renewed. Bread is clammy and sodden from bad yeast ferment- 
ing too rapidly, or when fermentation has not taken place ; cold weather, 
bad water, and other causes may retard it. 

Hot bread is but slowly digested, and in many people it excites dys- 
peptic symptoms. All kinds of bread, rolls, and cake, containing much 
shortening, and the different varieties of unfermented pastry, are more 
difficult of digestion if eaten while warm. 

According to Parkes, "in good bread there should be a due propor- 
tion, not less than thirty per cent, of crust ; the external surface should be 
well baked, not burnt. The crumb should be permeated with small, regu- 
lar cavities ; no parts should be heavy and without these little cells. The 



30 POOD. 

partitions between the cavities should not be tough, the color should be 

white, or brownish from admixture of bran ; the taste not acid even when 
held in the mouth. It the bread is acid, the flour is bad, or leaven has been 
used. It the color changes soon, and fungi form, the bread is too moist ; 
if sodden and heavy, the flour is bad, or the baking is in fault; the heat 
may have been too great, or the sponge is badly set." 

Bread cut up in slices and toasted properly is thereby rendered more 
digestible. The heat should not be too intense, or the outer surface will 
harden at the expense of the centre, which will be made softer. The 
toasting should be so managed that the slice will be crispy throughout its 
whole thickness. Toast should never be buttered while hot, as the presence 
of the fatty matter changed by heat renders it difficult of digestion. Bis- 
cuits, as generally made, are of simple composition, and therefore easy of 
digestion; they will keep unchanged much longer than wheaten loaves. 
Passover cakes are a thin biscuit composed only of flour and water. 

Wheat flour is the basis of a limitless number of preparations, moulded 
and flavored by the art of cookery, to tempt the appetite and appease the 
hunger of man. When animal fats are added to flour, and afterwards sub- 
mitted to heat, digestion is less easy, and often difficult ; pastry, for that 
reason, should be but sparingly indulged in, if at all. 

AVheat in its original state, flour, bread, and other preparations, may 
change by keeping, and become unfit for food. The presence of moisture 
is destructive ; one action induced by it is to render wheat and products 
strongly acid. Bread made from old and bad flour is acid, and sometimes 
highly so. Such bread often produces diarrhoea, though in some instances 
it has been used for a long time without this effect. In the presence of 
moisture bread becomes mouldy, and a similar change occurs in wheat- 
grains, and flour is subjected to the same influence. The fine hairy sub- 
stance which appears is a low form of vegetable growth, and it renders 
the articles over which it spreads dangerous for use. Instances in America 
have been reported where severe and even fatal poisoning resulted from 
eating spoiled or mouldy bread. Through the ignorance of his servant, the 
writer had two valuable dogs nearly ruined by eating bread so changed. 
A quantity of brown-bread was ordered from the baker, and thoughtlessly 
placed in a room rendered damp by a leak in the water-pipes. Mould soon 
formed, and for several days the animals were given their breakfasts from 
this spoiled bread. Intestinal derangement resulted, diarrhoea Avas soon 
followed by rapid emaciation and great exhaustion. Under treatment 
and careful nursing, recovery took place, but was delayed many months, 
during which the dogs suffered from a low type of gastric and intestinal 
inflammation. 

This vegetable growth is not peculiar to wheat and its products; it 
forms on other grains. Professor Vara ell states that "six horses died in 
three days from eating mouldy oats ; there was a large amount of matted 



OATS AND BARLEY. 31 

mycelium, and this, when given to other horses for experiment, killed them 
in thirty-six hours." 

Darnel grass, according to Christian, is the only poisonous species of 
the natural order of grasses. If this is allowed in the same field, the seeds 
might be harvested with the grains. Headache, giddiness, somnolency, 
delirium, convulsions, paralysis, and even death, are effects that have been 
observed to arise from their habitual consumption as an accidental ingre- 
dient of bread. 

Parkes says, "The most important disease connected with flour is ergot- 
ism ; this is less common in wheat than in rye flour, but yet is occasionally 
seen. Sometimes ergoted meal produces at once violent stomach and 
intestinal symptoms, at other times primary digestion is well performed 
and the early symptoms are great general depression and feverishncss, 
ushering in the local symptoms of acrodynia" (a painful affection of the 
wrists and ankles). The cause of ergotism is a vegetable growth which 
becomes developed on cereal grains, more especially rye. It presents the 
appearance of a spur, and hence the name spurred rye, which as a medicinal 
preparation is denominated ergot. 



BARLEY. 

Barley is largely used for malt, which is the product yielded when 
grain has been allowed to germinate and afterward kiln-dried. When 
employed as an article of food, barley is laxative in its action, and there- 
fore unsuited to dysenteric cases. The meal is sometimes mixed with 
wheaten flour and made into bread ; this product is by no means popular, 
as it is not easy of digestion, and has no agreeable flavor to recommend it. 

Scotch, or pot, barley is the grain deprived of its husk by milling. 
Pearl barley is the grain rounded and polished by friction. The patent 
barley is barley reduced by grinding. 

Barley, on keeping, and exposed to moisture, becomes materially 
changed. The symptoms which follow the eating of an altered quantity 
are the same as those caused by spoiled wheat. The patent barley is often 
adulterated by admixing the flour of cheaper grains. 

OATS. 

Oats have been considered more nutritious than wheat or barley, but 
from a lack of certain essential constituents the oatmeal cannot be made 
into bread, like wheaten flour. 

The common and most general mode of using oatmeal as a nutriment, 
is to boil it with water into a thick consistence, forming porridge 1 , or stir- 
about. In certain countries it is also made into thin cakes, by mixing into 
a paste with water and then baking on an iron plate. Dr. Cullen says: 



B2 FOOD. 

"Oatmeal is especially the food of the people of Scotland, and was for- 
merly that oi the northern parts of England, — countries which have always 
produced as healthy and vigorous a race of men as any in Europe." The 
Scotch oatmeal is more highly esteemed than the English; the former is 
ground coarser, and possesses higher nutritive value. 

Oatmeal may properly be said to have a laxative action, and it is there- 
tore recommended to those persons who suffer from habitual constipation. 
It should be eaten at breakfast, and in the form of porridge, or stirabout. 
In certain cases of dyspepsia, oatmeal is not well borne on the stomach, and 
therefore cannot properly be indulged in. 



RYE. 

Rye is a cereal rich in nutritive properties, and comes next to wheat in 
the facility with which its flour can be converted into bread. It is ren- 
dered serviceable as food by grinding, and is used under the form of meal. 
Bread is rarely made from rye alone, as its appearance and taste are unin- 
viting; it also lias a marked laxative action, and sometimes induces diar- 
rhoea. Bread composed of rye and wheaten flour is deservedly popular in 
some countries. In France it is quite common to sow and reap the two 
cereals and have them ground together. This mixture makes a nutritious 
and not unpalatable bread. 

Ergotism is more common in rye than in any other grain. According 
to Pereira, " the affected grain undergoes development so as to project 
considerably beyond the husk, and it may attain upwards of four times its 
size in the ordinary state. On account of this excessive growth, it can be 
separated by sifting from the unaffected seed, and, unless this is done to an 
ergotized crop, serious consequences may arise from its consumption as 
food. At various times, indeed, the inhabitants of different parts of the 
Continent have been stricken with fatal illness from this cause. Two 
classes of symptoms are produced, denominated the convitlsive and gan- 
grenous forms of ergotism. In the one, the phenomena consist of weari- 
ness, giddiness, contractions of the muscles of the extremities, formication, 
dimness of sight, loss of sensibility, voracious appetite, yellow countenance, 
and convulsions, followed by death; in the other, there is also formication, 
that is, a feeling as if insects were creeping over the skin, and voracious 
appetite, and with this there occur coldness and insensibility of the extremi- 
ties, followed by gangrene." 

INDIAN CORN, OR- MAIZE. 

By the people of the American continent, Indian corn is held in high 
esteem as an article of food. It has much the same nutritive value as 
wheat, and contains about four times the amount of fatty matter. Green 



INDIAN CORN. — It ICE. 33 

corn is a favorite delicacy, and is gathered when nearly full-grown, and 
boiled or roasted. After ripening, drying, and shelling, corn is converted 
into meal by grinding, but occasionally the grains arc eaten unbroken. The 
"hulled corn," probably less popular at the present time than formerly, is 
the grain subjected to a process of soaking and boiling. This is usually 
eaten with milk. 

Indian meal, coarsely ground, constitutes the hominy of the South. 
The meal commonly used is much finer, and is occasionally submitted to 
the process of bolting. It is not adapted to bread-making, as it lacks that 
essential constituent, gluten. The brown bread of New England is made 
of a mixture of rye and Indian meal. 

From the amount of oily matter which it contains, maize is the most 
common food used for feeding and fattening animals. As an article of 
diet for man, it is of great importance, as, when properly prepared, it is 
wholesome, digestible, and nutritious. Persons suffering from habitual 
constipation, will find corn bread a gentle laxative, which will aid much in 
overcoming the derangement. Its action is of an irritant character ; it 
stimulates the walls of the intestinal canal through which it passes. 

RICE. 

According to Pavy, rice is said to supply the principal food of nearly 
one-third of the human race. The best rice is brought from Carolina and 
Patna. The fields in which it is raised, called paddy fields, are periodically 
flooded with water, as the plant requires a constantly wet soil for its growth. 
Before ripening, the water is drained off, and the crop is cut with a sickle. 

The rice-grains, as they appear in the shops, have passed through two 
preparatory processes. The husk is first removed, then the grain is sub- 
mitted to a second operation, which detaches the inner or red skin. 

The principal constituent of rice is starch, and other nutritive elements 
exist in only small amounts. For this reason rice, as food, must be asso- 
ciated with articles to compensate for this deficiency of its principles. If 
properly cooked, it is very easily digested, and therefore much esteemed in 
the sick-room. 

Rice should be steamed, not boiled, and the steaming should be thor- 
oughly done, else the starch-grains are not properly acted upon, and if not, 
they are much less digestible. By boiling, the grain loses its nutritive 
power, if the process is prolonged. Rice flour is less rarely consumed as 
food than in the form of grain. When mixed with wheaten flour, it fur- 
nishes a very white bread, especially popular among the Parisians. 

Rice is analogous to the potato, and, like it, is largely used in the manu- 
facture of starch. The process adopted is to treat the flour with a 
solution of caustic soda, which dissolves other constituents, and leaves the 
starch-granules intact ; thev are afterwards washed and dried. 



FOOD. 



BUCKWHEAT. 

kwheat is commonly referred to in connection with the cereal 

I: does not as extensively enter into the diet of man as any of 

the cereals already described. Indirectly, it contributes to his support, by 

furnishing a food of which domestic animals are very fond. When given 

- : : is said to cause them to yield an abundance of milk, from which 

1 butter and cheese are made. It is eagerly eaten by poultry, and is 

sometimes given to horses, mixed with oats. 

The flour of buckwheat is rarely used for bread, as it is devoid of 
ten. In this country thin cakes raised with yeast are made from it, and 

constitute a popular article offered for breakfast. 

LEGUMINOUS SEEDS. 

The leguminous, or podded seeds, are numerous ; a few only, however, 
are applicable for human food. Beans and peas are the only two varieties 
which sufficiently enter into the diet of man to be deserving of special 
mention. These constitute most valuable articles of food, as they contain 
a much larger amount of nutriment than the cerealia. 

They furnish a food more satisfying than vegetable food generally to 
the stomach, and in this respect approach meats in dietetic value. They 
are an excellent substitute for animal food, and both men and beasts can 
be nourished on them alone for some time. The disadvantage of beans 
and peas is a certain amount of indigestibility ; a small per cent passes 
out of the body unchanged. They are apt to occasion a collection of 
wind in the stomach and bowels, which, in turn, not infrequently causes 
colic. They are heat-producing and strength-giving; the "loggers" of 
the northern part of Maine, exposed to the most intense cold, demand at 
least one meal a day of beans, their favorite article of food. From the 
peculiarity of their composition they can wisely be associated with other 
substances, in which starch and fat predominate. It is said that they with 
an admixture of rice constitute the staple food of a large population in 
India. The pork and bean< of New England are therefore a combination 
sanctioned bv dietetic law. 



BEANS. 

There are several varieties of beans ; some are employed as food for 
cattle. The Windsor bean is the most common product of gardens, and 
when boiled in the young and fresh state, it is a favorite article of man's 
diet. 

Haricots or French beans are the common kidney beans, and in the 
green state are an esteemed edible. In the shops of America, the beans 



TUBERS AND ROOTS. 35 

which in the dried state are most commonly sold, are classified as the pea, 
medium, yellow eye, red kidney, and marrowfat; they are in demand in 
the order named. 

PEAS. 

In this country, peas are largely consumed in the green state, and are 
among the most succulent vegetables. If allowed to mature, they lose 
their color on keeping, become very pale, shrivelled and extremely 
hard. 

Pavy says: "Peas when young are tender and sweet, and are far 
more digestible but less nourishing than peas in the matured state. The 
latter, like other leguminous seeds, require slow and prolonged cooking to 
render them soft and digestible. When old, no amount of boiling will 
soften them ; indeed, the longer they are boiled the harder they become. 
In this condition they should be soaked in water for some time, and then 
crushed and stewed, or treated in the same manner as dried peas, to render 
them palatable and digestible." 

TUBERS AND ROOTS. 
POTATOES. 

The potato constitutes one of the most wholesome and popular edibles. 
Owing to a deficiency of certain important nutritive principles, it does not 
form a suitable food alone, but with other vegetables and flesh rich in those 
absent properties, the potato supplies a most pleasing part of man's diet, 
and one always welcomed by him. 

While it contains only a small amount of nitrogenous matter, and 
hardly any fat, the potato abounds in starch, and the vegetable acids 
and their salts. The juice is an acid of high repute as an anti-scorbutic. 
In the manufacture of starch it enters largely, and to many other purposes 
science has applied this important vegetable. Farinaceous preparations, 
among them arrow-root and tapioca, are adulterated with the starch 
obtained from the potato. It is often ground and added to wheaten flour 
and the product sold as a cheaper grade of the latter. Potatoes by mash- 
ing and mixing them with malt are converted into ardent spirits ; one 
hundred pounds of the vegetable is said to yield one and two-thirds gallons 
of proof spirits. The purposes to which this vegetable can be applied are 
so many and varied, to estimate its usefulness to man would be exceed- 
ingly difficult. 

In cooking potatoes, the steaming process is the best, as by it there is 
no loss of nutritive value. If boiling is employed, the skins should not be 
removed or a large amount of the salts which they possess passes into the 
water. Dr. Letheby says that when potatoes are cooked in their skins, 
only three per cent is wasted, or half an ounce to the pound, whereas when 



POOD. 

they are peeled first, the Loss is not loss than fourteen per cent, or from two 
to throe ounces in the pound. If salt is added to the water in which pota- 
toes are boiled, fewer oi the salts then pass out. The boiling must be 
complete, as the starch-grains are otherwise insufficiently acted upon to be 
of digestion. It also must be slow, else certain other constituents 
are hardened, and the potatoes, instead of being mealy, are close and 

I potato is now very extensively cultivated in America. It is 
a popular article of food for occasional indulgence, but the appetite for it 
is - ai satiated. It is less easy of digestion than the white potato, and 
dyspeptic symptoms are invited, if it is eaten freely with animal food. The 
t potato can be cooked by boiling or baking. Either process must be 
continued until it is rendered soft and mealy. If much of it is indulged 
in, a laxative action is generally manifested. 

Other tubers enter into the diet of man, among them the yam and arti- 
choke. They are not consumed to a large extent, and are therefore unde- 
serving of special mention. 



CARROTS. 

The carrot is a wholesome vegetable food for both man and cattle. 
Those suffering from gastric derangements find it less easy of digestion. 
The bark, as it is called, is of the darkest color, and of a pulpy consis- 
tence ; it is also sweetest, to the taste. The wood or heart, especially when 
the root has attained its full size, is more fibrous and stringy. As the 
external part of the bark is found to be more nutritious than the central 
part, consecjuently the value of the carrot, as food, will depend on the 
relative proportion of those two parts. 

THE PARSNIP. 

The root of the parsnip is wholesome, and can be eaten safely by those 
in whom the digestive system is unimpaired. Dyspeptics, who suffer from 
heartburn and flatulence, will do well to deny themselves this article of 
food. The robust laborer, or he who takes much and active exercise in 
the open air, requires no counsel in the use of this or other vegetables, 
except that it will be prudent, if he eat much animal food, to take a larger 
proportionate allowance of these, and other watery vegetables, than would 
be necessary if his food were chiefly of the farinaceous kind, with little 
meat. 

In some countries, parsnips are used in the manufacture of wine, and 
in the north of Ireland, with the aid of hops, a beer is brewed from 
them. 



TUBERS AND BOOTS. 37 



THE TURNIP. 

The turnip appears to have been applied to more extensive uses, as an 
eatable, in former times than at present. It is recorded that in the years 
1629 and 1630, when there was a scarcity of grain in England, very good 
and wholesome bread was made of boiled turnips, deprived of their moist- 
ure* by pressure, and then kneaded with an equal quantity of wheaten 
flour. It is said that this bread could not be distinguished, by the 
eye, from a wheaten loaf; neither had it a markedly characteristic 
odor. 

Turnips should be peeled before boiled ; the outer covering, which con- 
tains an acrid principle, should be pared off to a considerable depth. As 
they consist chiefly of water combined with a soluble or nutritive matter 
in a very small proportion, their value as an article of diet depends largely 
upon the agreeable flavor which characterizes them. Turnips, when 
properly cooked, are digestible, but their use by dyspeptics is contra- 
indicated. 

THE BEET-ROOT. 

In nutritive properties, the beet-root is a vegetable which ranks next to 
the potato. In the United States it is a favorite article of food, and after 
having been boiled it is usually cut in slices and eaten with the addition of 
vinegar. It is somewhat more easy of digestion, than the turnip, carrot, 
and parsnip. From the juice of the beet-root, sugar of excellent quality 
is extensively manufactured. 



RADISHES. 

In composition, the radish closely resembles the turnip. It is usually 
eaten in the raw state, an-d is of an agreeable flavor. By a slight stimu- 
lant action on the mucous membrane of the stomach, it favors the digestion 
of other foods. 

There are black, violet, red, and white radishes, but the color varies 
only on the exterior; the central portion in all is white. 

Some of the so-called farinaceous preparations are obtained from roots 
rich in starchy matters ; among them are tapioca and arrowroot. 

Tapioca is prepared from the plant properly called the cassava, of 
which there are two varieties, the bitter and the sweet. It is of but little 
nutritive value, but forms a pleasing and digestible article of food, espec- 
ially popular in the sick-room. 

Arrowroot is largely restricted in its use to invalids, and, as it consists 
solely of pure starch, it has but little sustaining power, and opposes but 
slightly the waste of bodily tissues. 



FOOD. 

s i may not improperly be referred to in connection with the fore- 
going, as one of the important farinaceous preparations, although it is 
obtained from the stems oi a plant instead of from the roots. It is 
yielded by the pith of the stalks oi several species of palm. Sago is an 
important article of food, as it is light and digestible, useful both for the 
sick and the healthy. 

HERBACEOUS ARTICLES. 

In this class are included the leafy parts, shoots, and stems of plants. 
They are valuable as articles of food, by reason of their agreeable flavor, 
and the salts which they contain. The proportion of solid matter is very 
small ; water is their principal constituent. To make them tender, and 
pleasing to the taste, the intervention of the gardener is necessary, 
and he forces their growth by partial exclusion of the light. If 
left to nature, their fibres harden, and the taste becomes strong and dis- 
agreable. 

Among the many products of the cabbage tribe, the most important are 
the white, red, savoy, and cauliflower; these may be deemed wholesome 
and pleasing ingredients of diet. They contain ninety per cent of water, 
and therefore can contribute but little to the nutrition of the body; the 
salts which they supply, are, however, among those essential to the main- 
tenance of health. They cannot be recommended where weakness of the 
stomach exists, as they are articles of difficult digestion. 

The white cabbage is the common variety, and, by reason of economy, 
next to the potato, it is the vegetable most popular with the laboring 
classes of America. In Germany it is more universally esteemed, as it fur- 
nishes a food which may not improperly be identified with that nation. 
Sauer-JKravt is made from the cabbage leaves submitted to acid fermenta- 
tion. In its preparation a machine is used, constructed on the principle of 
a carpenter's plane, and employed as that tool would be when inverted. 
The "heads" are, as it were, planed down, the knife cutting them into 
small slices. These are then placed in a barrel, in alternate layers with 
salt, and the entire mass is subjected to the pressure of heavy stones. In 
from two to three weeks acid fermentation is sufficiently advanced to 
render the cabbage eatable, after being well boiled. Sauer-JSraut is much 
more easily digested than the vegetable in its original and unchanged 
state. 

The red cabbage is chiefly used for pickling, as when cooked in the 
fresh state its flavor is less pleasing, and it is more of a burden to the 
stomach than the white variety. 

Savoy is the name applied to a variety of cabbage characterized by 
wrinkled leaves. It is commonly selected for winter use. 

Cauliflower. This is one of the most highly esteemed delicacies 



HERBACEOUS ARTICLES. 39 

derived from the cabbage tribe. It is the product of cultivation, and con- 
stitutes the flowering of the plant, which has been trained to grow into a 
compact mass or head. 

Among the many vegetables the leaves of which are commonly con- 
sumed by man, the most important are spinach, lettuce, and water-cress. 

The spinach yields leaves which when eaten are wholesome and easily 
digested ; as is the case with all herbaceous parts dark green in color, they 
possess slightly laxative properties. 

The lettuce is a plant the leaves of which cannot be too highly esteemed 
as food, as they are digestible and of pleasing taste. There are many con- 
ditions of the system, among them plethora, which contra-indicate the 
excessive use of the coarser vegetables ; in such cases, lettuce satisfies the 
appetite and exerts a cooling effect. 

The water-cress is a creeping plant which grows near springs and in 
slow-running streams. It is wholesome, and of pleasing, aromatic taste. 

Among vegetables the shoots and stems of which are used as food, 
rhubarb, celery, and asparagus are the most common. 

Hhubarb. This yields one of the most useful garden products. The 
stalks of the leaves when cooked are not only easily acted upon by the 
stomach, but also assist in the digestion of other substances which enter 
with it. 

Celery is one of the most fragrant plants the products of which are used 
as food. In its wild and uncultivated state, it is of rank flavor and pecu- 
liar smell; the art of the gardener makes the stalks tender and agreeable 
to the taste. They are covered with dirt as they grow, the leaves only 
being allowed to appear above ground. By this means light is excluded, 
and the shoots are kept white, mild, and sweet. Celery should not be 
eaten with or after a hearty meal, as the stomach at that time is sufficiently 
taxed, and unable to bear the additional burden which this vegetable 
would impose upon it. When taken at lunch, with bread and cheese, it is 
easily digested, and a most pleasing relish. 

Asparagus. The young shoots of this plant are universally esteemed 
as a choice and delicate food. They contain a certain principle called 
asparagin, which stimulates the kidneys and gives a peculiar odor to the 
urine. They should be eaten as soon as possible after cutting, as they are 
then wholesome, and not difficult of digestion. Certain medicinal virtues 
have been attributed to asparagus, whether properly so or not has not 
been proved. 

Chambers says: "The solution of mere flavoring herbs, such as onions, 
garlic, mint, tarraon, etc., is not a matter for the dietician to discuss. IK' 
may, however, say one word in favor of temperance in their employment. 



40 F« K>D. 

An excess makes us unpleasant to our neighbors, and, disguising the true 
flavor of the moat, it Leads to our putting up with an inferior article. The 
object t<> be aimed at in their use, is to promote the secretion of digestive 
ents, and the degree in which they attain this object may be judged by 
the watering of the mouth; a whiff of them excites the flow of saliva, a 
copious dose runs it dry.** 

The so-called fruity products consumed as vegetables are the pumpkin, 
-quash, cucumber, and tomato. The first two are especially esteemed as 
food by the Xew Englanders. They are palatable, soft to swallow, and 
wholesome, but do not form a substantial diet. 

The cucumber in the raw state is extremely indigestible, and to it may 
be safely attributed many dysenteric attacks. It is not a suitable ingredi- 
ent of a heavy meal, as the quantity of woody fibre in it adds to the 
burden of the stomach, already loaded with all it can digest. If eaten at 
all, it should be at lunch ; then, if salt, pepper, and vinegar are freely used, 
to stimulate the secretion of gastric juice, the cucumber occasions less dis- 
turbance. When j^ickled in vinegar, this vegetable becomes an agree- 
able relish, and assists in the digestion of other articles of food used 
with it. 

The tomato is highly popular, and Americans especially consume large 
quantities of this vegetable. While yet green, it becomes an ingredient 
of the so-called " mixed pickles." When ripe it is eaten raw, in salads, 
stewed, and in various other forms. It is extensively used in the manu- 
facture of tomato ketchup, and no other vegetable is so extensively 
M canned." 

Certain vegetable products are termed fungi, and among the consider- 
able number of varieties consumed as food, mushrooms and truffles are the 
most important. 

Mushrooms so closely resemble toadstools, few people dare to indulge 
in them, if forced to depend upon their own discernment. They are, 
therefore, more of an occasional delicacy than a common article of food. 
Dr. Christian says that a sure test of the poisonous fungus is an astringent, 
styptic taste, and perhaps also a disagreeable, but certainly a pungent, 
odor. He also says that most fungi which have a warty cap, and, more 
•ially, if there be fragments of membrane adhering to their upper 
surface, are poisonous. 

Chambers says mushrooms are best when grown in an open meadow. 
When forced, they are tough and indigestible, and when preserved, they 
are tnsteles^. as well. A meadow mushroom should peel easily, and be of 
a clean, pink color inside, like a baby's hand, and have a frill, or '-curtain" 
fas botanists call it), attached to the stalk. When the gills are brown, 
they are growing old and dry, and losing their nutritive qualities. 



FRUITS. 41 

Truffles are a delicacy highly esteemed for their peculiar aroma. 
There are three varieties, the black, white, and red; the first is valued the 
most. 

Pavy says that they do not appear above the surface; there is nothing 
to indicate the locality of their growth, but their odor enables them to be 
scented out by animals employed for the purpose. In England, dogs are 
trained for this work. They scratch and bark over the spot where they 
grow, and then men dig them out. In France, pigs are used in the same 
way. This animal appears to be very fond of them, and, on discovering 
their situation, turns up the ground with its snout in search of them. 

They should be eaten while fresh and sweet; the agreeable aroma 
which characterizes them when in that state is lost by keeping, and when 
decomposition sets in, the odor is intolerable. 

FRUITS. 

The term fruit is properly restricted to articles like apples, oranges, 
plums, etc. While there are many varieties, yet, as the principles in all 
are essentially the same, a consideration of each is unnecessary. 

Good ripe fruit forms a pleasing and refreshing kind of food, and, eaten 
moderately, it is influential in promoting bodily health by contributing 
some of the materials of the blood, of importance to the general vigor of 
the constitution. Herodotus attributes the activity and healthiness of the 
Persian race to the variety of fruit and vegetables consumed by them. 
Chambers says that he feels sure that the puuiness, infertility, pallor, fetid 
breath, and bad teeth which distinguish some of our town populations is, 
to a great extent, due to their inability to get these articles of the table 
fresh. For the unhealthy state induced by a restricted diet of dried and 
salted provisions, fresh fruits, or their preserved juices, are specially 
efficaceous. 

Fruit, eaten beyond the limit of moderation, is liable to prove injurious, 
and excite intestinal derangement. It is more of a disturbing element, if 
eaten either in the unripe or over-ripe state ; in the former case, from the 
excessive quantity of acid present; in the latter, from the tendency to de- 
compose while being acted upon by the digestive organs. 

Authors have essentially differed in the proper time of the day for 
taking fruits. Some have stated that they may be treated as mere luxuries, 
to be eaten at any and all times. Chambers says that the safest time is in 
the morning or afternoon, with stale bread and a draught of water. Thus 
may be made a very wholesome and digestible lunch. The worst time is 
after a heavy dinner. Adults often complain that they cannot enjoy fruit as 
their girls and boys do; the fact is, they eat it at a wrong hour of the day. 

Among those fruits most digestible may be considered strawberries, 
oranges, grapes, peaches, figs, and cherries ; apples, pears, plums, and 



- 

Bt rhile melons and other cold watery fruits are not only 

h. but also retard the _ : la vith 

which they may be uiii._ 

common fruits there are a small number which may 

irately. 

In the r must be consid mewhat difficult of 

. and that the habit common with many of eating lit before 

retiring is an unwise one, wakeful hours and disturbed sleep gives i : lple 

uouy. When cooked, it is light and digestible ; roasted apples have a 

•tion, and those suffering from habitual constipation will 

find much benefit from their persistent > 

P - is one of the most useful and agreeable of 

common fruit* hngly grateful an<^ Log to the 

and, in the ripe state, it is so little likely to occasion disorder as to be 
admissible under almost every condition, both of sickness and of health. 
- is quite true of the juice of the fruit, but the fibrous partitions are 
much more slowly acted upon by the digestive fluids, and should e 
rejected by invalids suffering from gastric or intestinal irritations. 

is a fruit much used in the sick-room, and, many times, 
unwisely. Lemonade, being a very refreshing and agreeable drink, is 
easily taken in excess by persons suffering from fevers, a fact which should 
not be forgotten. In typhoid fever, for instance, its immoderate use 
would be attended with danger, inducing, as it might, additional derange- 
ment in an already inflamed intestinal mucous membrane. In all inflam- 
iua* : the stomach and bowels, lemonade should only be give 

after the attending physician has sanctioned its us 

During the past few years, lemon juice has become quite popular 
agent in the treatment of diphtheria, from its supposed action on the mem- 
branous deposit in the throat. There have also been attributed to the 
juice marked virtues in the functional derangements of the liver, commonly 
denominated as "bilious di- - S me ossc iffected have found 

benefit from its persistent use, the symptoms of others have bet:: _ _ - 
it. 
Plums should only be eaten in moderate quant:: best they are 

more grateful to the taste than wholesome. When too freely indulged in, 
diarrhoea and colic not infrequently follow as a consequei: 

. like plums, are particularly liable to dis :he bowc Is, if 

many aie eaten. There is a popular prejudice that if the stones of the 
fruit are swallowed, it will obviate this tendency to intestinal disturbance. 
N thing could be more absurd than this theory, and the practi 

nicious one, as it invites e - inflammation, if not fatal con- 

seque 

•ne of the most highly esteemed of fruits, and the juice 
a wholesome, nutritious, and cooling properties. The same ridicu- 



OLEAGINOUS SEEDS. 43 

lous notion which prompts many people to swallow cherry-stones, leads 
them to do the same with grape-seeds. These, and the skin, are indigesti- 
ble, and should be rejected. In preparing raisins for puddings, pics, etc., 
the seeds should always be removed. The grape in the dried form possesses 
much less of the acid principles, and abounds largely in sugar. Raisins, 
therefore, are richer, and much more liable to disturb the digestive organs. 



OLEAGINOUS SEEDS. 

Nuts are the oleaginous seeds, characterized by an absence of starch}', 
and an abundance of oily, matter. By them, Chambers says, nature has 
not done justice. They contain an enormous proportion of a valuable 
nitrogenous element, which in the almond exceeds half its weight, and is 
called "emulsin," from its diffusibility without solution in water; yet this 
is so cut off by its natural concentration and hardness from the action of 
the gastric juice, that it is scarcely digested at all, unless chewed and 
cooked much more than is usual. When chosen for food, they should be 
used in extreme moderation, and at a time when the stomach is at leisure, 
and can devote all its powers to their solution. When pounded and em- 
ployed as a flavoring, they are innocent enough. Frying them in butter, 
salt, and pepper makes a tasty, wholesome hot dish for dessert. 

The almond is one of the most important of the oily seeds. There are 
two varieties, the sweet and the bitter. They both contain a lixed oil, of a 
perfectly innocent character, which is expelled by pressure. The bitter 
almond alone yields the principles for the develoj^ment of poisonous pro- 
ducts, hydrocyanic or prussic acid. 

The skin of the almond is irritating to the throat and stomach, and for 
that reason it should be removed by soaking the seed for a short time in 
warm water; the process is termed "blanching." 

The cocoa-nut is a fruit which yields a fleshy, edible portion, which 
contains about seventy per cent of fat. The oil or butter, which is 
extracted by heat, has certain medicinal virtues, and is a frequent ingre- 
dient of druggists' preparations. The so-called meat of the nut, in its 
natural state, is digested w T ith difficulty ; cooking renders it somewhat less 
burdensome to the stomach. 

A story illustrating the nutritiousness of the milk of the cocoa-nut has 
lately been reported. It seems that a vessel left San Francisco with four 
hundred passengers for Sydney, and, in consequence of running short of 
stores, put in at Samoa, where a large quantity of cocoa-nuts were 
obtained. The weather became so severe that the remainder of the pas- 
sage consumed eight days, so that men, women, and children were reduced 
entirely to a cocoa-nut diet, and were obliged to be contented at 
last with but one per diem for each adult. "Notwithstanding this 
diet," says the report, "not a life was lost, and not a single case of 



44 FOOD. 

siekness occurred, all the | ra landing in a healthy and well nour- 

. condition." 

- f many other nuts are used as article 1, or from 

them are obtained oils important in cookery and confectionery. 

Among the vegetable oils, that which is obtained from the oli 

doubtless, the most common. It is nutritions, mildly laxative, and easily 

borne on the stomach. Much of the so-called olive or salad oil found in 

America, is an adulterated or spurious article, made largely 

of the oil of the cotton-seed. Olive oil, as it is sold, is largely used by the 

31 skilful cooks in frying- foods, they quite rightly assuming that the 

_ table oils, after being sed to heat, arc much less burdensome to 

the stomach than animal oils. 



CHAPTER II. 
ACCESSORY POODS. 

A number of articles, among them tea, coffee, cocoa, and chocolate, 
may properly be denominated accessory foods. While they are not abso- 
lutely essential to the nutrition of the body and the maintenance of health, 
yet the use of them is so extended, they must be acknowledged a part of 
man's diet. 

Tea has practically no nutritious value, yet, as one author says, "that 
it supplies some hidden want of our nature, might be inferred from its 
widespread use." One of its most marked physiological effects is felt 
after great exertion ; it then acts as a diffusive stimulant, by refreshing 
the body and renewing mental activity. Chambers' testimony is that it 
soothes the nervous system when in an uncomfortable state from hunger, 
fatigue, or mental excitement. 

Tea quickens respiration, it excites the skin to greater activity, induces 
perspiration, and thereby lessens the force of circulation, and lowers the 
bodily temperature. Upon the mind, the stimulating and re-invigorating 
influence is manifested by increased vivacity of spirits, renewed energy, 
and diminished tendency to sleep. 

Pavy says: "To express in a few words the advantages derivable from 
the use of tea, it may be said that it forms an agreeable, refreshing, and 
wholesome beverage, and thereby constitutes a useful medium for the 
introduction of a portion of the fluid we require into the system. It 
secures that the water consumed is rendered safe for drinking by boiling, 
which is necessitated as a preliminary operation in making tea. It cools 
the body when hot, probably by promoting the action of the skin ; warms 
it when cold, by virtue, it would seem, of the warm liquid consumed. In 
a negative way it may prove beneficial to health, by taking the place of a 
less wholesome liquid. Through the milk and sugar usually consumed 
with it in England, it affords the means of supplying a certain amount, 
and not by any means an insignificant amount, viewed in its entirety, of 
alimentary matter to the system. Experience shows that it often affords 
comfort and relief to persons suffering from nervous headache. It also 
tends to allay the excitement from, and counteract the state induced by, the 

45 



46 ACCESSORY FOODS. 

use of alcoholic stimulants; and, further, on account of its anti-soporific 
properties, like coffee, it is useful as an antidote in poisoning." 

One of the most important constituents of tea is an astringent matter, of 
the nature of tannic acid. This agent has an acknowledged action on the 
mucous membrane of the kidneys and bladder, and, in certain derange- 
ments of those organs, tea can be wisely employed for its medicinal 
virtues. By reason of this constituent, patients taking certain prepara- 
tions of iron as tonics are forbidden indulgence in tea; a chemical reaction 
lakes place when they are united, and the tannate of iron, an inky fluid, is 
formed. 

In the selection of tea, the best is of the most agreeable taste, and con- 
tains an excess of the characteristic sedative principles. These principles 
consist of an essential oil, the odor of which is strongest in the finest teas, 
and weakest in the inferior grades. Green tea should properly contain 
much more of the essential oil than black, but by reason of its higher 
price it is often adulterated. The finest teas are said to color the water 
the least. After boiling water has been poured on the leaves, it should 
not be allowed to remain long, as the infusion soon loses its delicate aroma, 
and other constituents are extracted, which gives it a coarse and bitter 
taste. 

"While tea in moderate quantities acts as a pleasing stimulant, promi- 
nent and uncomfortable symptoms appear if an excess is indulged in. The 
nervous and muscular systems are weakened, the heart acts irregularly, 
and the digestive organs become deranged. 

COFFEE. 

Certain physiological effects are peculiar to both tea and coffee. They 
are restorative and stimulating, and no depression follows their moderate 
use. Coffee acts more powerfully on the circulation than tea, and it better 
supplies the place of food by its satisfying effect upon the stomach. The 
soldiers and sailors on active service appreciate its valuable properties, and 
sustaining influence under fatigue and privation. Dr. Hayes testifies to 
the effects of tea and coffee, and their superiority over alcohol in enabling 
men to endure cold and hardship in the Arctic regions. "They both 
operated upon fatigued and over-taxed men like a charm," but coffee was 
preferred in the morning, and tea in the evening. "The coffee seemed to 
last throughout the day, and the men seemed to grow hungry less rapidly 
than after drinking tea ; while the tea soothed them after a day's hard 
labor, and enabled them to sleep better." 

Dr. Edwin Smith made many interesting experiments, and studied close- 
ly the action of these beverages. He says: "The conditions under which 
coffee may be taken are very different from those suited to tea. It is more 
fitted than tea for the poor and feeble. It is also more fitted for breakfast, 



cocoa. 47 

inasmuch as the skin is then active and the heart's action feeble; whilst, in 
good health and while with sufficient food, it is not needful after dinner, 
but if thus drank, should be taken soon after the meal. Hence, in certain 
respects, tea and coffee are antidotes of each other, and we know thai they 
are not taken indiscriminately, although in a chief action they are inter- 
changeable." 

On some people coffee acts as a mild laxative; others complain that it 
induces constipation. In cases of opium-poisoning it is employed for its 
sleep-opposing qualities, and in some forms of nervous headache it affords 
relief. Those who suffer from the purely spasmodic form of asthma find 
coffee a valuable agent for controlling the paroxysms. 



COCOA. 

Cocoa constitutes a product derived from the Theobroma cacao, a tree 
common to South America and the West Indies. The term cocoa, as 
applied to this product, would intimate a relation to the cocoa-nut, but 
none exists, as that fruit is borne by a tree of an entirely different 
species. 

As an article of diet, cocoa may be compared with milk. It contains 
a large quantity of fat and other nutritive properties, which render it 
very nourishing, and, therefore, useful in debilitated states of the system, 
and for healthy men while undergoing great muscular exertion. 

Chocolate is the extract of the cocoa-seeds, incorporated with sugar to 
the extent of nearly one-half its weight, and flavored with vanilla, cinna- 
mon, or some other aromatic. Considering the process of manufacture, 
adulteration is easy, and doubtless much of the chocolate found in shops 
is largely made up of baser ingredients. The cocoa nibs are the 
kernels of the roasted seeds, deprived of husk and broken up by 
rough grinding. These are used as a mere beverage, like tea or coffee. 
As much of the nutriment exists in the thick grounds, the mere infu- 
sion has no sustaining power, and if to support and nourish is the purpose 
for which the plant is used, then it should be employed in the form of 
chocolate. 

Pure cocoa contains twenty-five times as much fatty matter as wheaten 
flour, and the large proportion of this constituent renders it burdensome to 
a delicate stomach. It is therefore unsuited to invalids suffering from 
gastric or intestinal derangements. 



ALCOHOL. 

The subject of alcohol is one of no little importance, cordially inviting. 
as it does, prejudice and assumption. Some writers are unwilling to con- 
cede to stimulants the virtue they possess, while others exaggerate their 



48 ACCESSOR? FOODS. 

dietetic value. Excessive indulgence in spirituous liquors can never be 
combated by intemperate denunciation, and the author has felt that igno- 
rance oi the actual dangers to health from the abuse of alcohol, is a condi- 
tion favorable to the propagation of the great evil. By treating the 
subject fairly and impartially, it is hoped that a better understanding of 
the physical and moral effects will influence the reader to discourage 
intemperance. 

Although many experiments have been made, and scientific observers 
have dwelt long and patiently on the subject, the exact physiological 
action of alcohol, after it is taken into the stomach, is not as yet definitely 
determined. According to Parkes, it is absorbed without alteration, or 
perhaps in some degree converted into acetic acid, possibly by the action 
of the mucus, or secretion of the stomach. The rate of absorption is not 
known, and it has been supposed that, when given in very large quantities, 
it may not be absorbed at all. After entering the blood, it is then equally 
distributed throughout the body, and soon commences to pass out by the 
lungs, skin, and kidneys, and a very small portion is expelled by the 
bowels. It was formerly supposed that the entire quantity of alcohol 
entering the system was thrown off, but this theory has been disputed by 
so many intelligent experimenters that it is now generally believed that 
some, and perhaps much, is destroyed and disappears in the body. The 
mode of destruction, and the point where the change takes place, is 
unknown. It has been assumed that it is transformed into acetic acid, and 
that this is a correct theory is by no means improbable. 

In carefully considering the influence of alcohol on the different 
organs of the body, it is apparent that, while, in very small quantities, 
it aids digestion, in larger amounts it checks it. Immoderate indulgence, 
if persisted in, soon destroys the appetite, inflames the mucous membrane 
of the stomach, produces a chronic catarrh of the same, and eventually 
causes degenerative changes in the tissues and glandular svstem of this 
important organ. The action of small quantities of alcohol on the liver is 
not known, but intemperance in its use causes an enlargement of the 
organ ; the integrity of its structure becomes affected by abnormal 
deposits, and waxy or fatty degeneration ensues. Following this increase 
in size, or occuring independently of it, destructive changes take place in 
the tissues, a shrinking of the covering of the organ arrests the perform- 
ance of its functions, by contracting its vessels and destroying its secretory 
apparatus. Finally, the organ becomes the so-called " drunkard's liver," 
wasted and powerless. 

If large quantities of alcohol are habitually taken, changes are induced 
in the lungs; chronic bronchitis and dilatation of the air-cells are the most 
common results. As the result of experiments, it is safe to assume that 
less carbonic acid, for a time, is expired after alcoholic stimulants have 
been indulged in. 



ALCOHOL. 40 

According to Dr. Parkes, brandy in a healthy man augmented the 
rapidity of the heart thirteen per cent, and the force was also increased. 
The consequence of continued stimulation can be readily appreciated. 
Nature, in the constructive of the circulatory system, designed that this 
most important organ should contract a certain nun; her of times per 
minute. Most indulgently she made provisions for an occasional increased 
action, to conform to the common experiences of man. Its labors may be 
taxed for hours, even days, and yet, if a reasonable period of rest is 
allowed, its integrity will be restored. But there is a limit to this recuper- 
ative power, and disease is inevitable if the line is passed. If an engine 
constructed to make one hundred revolutions per minute, is continuously 
driven to higher speed, the wear will be proportionately greater. So with 
the heart, the engine of the body, the vital organ of life. It was designed 
to make so many pulsations per minute, and if the proper performance of 
its functions is not interfered with, then, when old age is reached, its action 
will still be vigorous and healthy. But if abused, and taxed beyond rea- 
sonable limits, by the continuous use of stimulants, its rest is shortened, 
nutrition suffers, it becomes enlarged, then dilated, and finally worn 
out. 

Alcohol on the nervous system is a stimulant, in ordinary doses, but, in 
very large amounts, it has a paralyzing effect on the nerve-centres. It has 
no particular tendency to excite active inflammation of the membranes, 
although, it is liable to produce in them chronic nutritive changes. By its 
habitual use, the brain becomes atrophied and hardened, or, in consequence 
of the diseased state of its blood-vessels, the substance softens, and hem- 
orrhage into it frequently occurs. 

Whether the action of alcohol on the muscular system is direct, or 
through the nerves which control it, is an unsettled question. A small 
quantity interferes w T ith the finer combined movements, such as are 
required to thread a needle, and muscular power is lessened in proportion 
to the amount indulged in. That the effect of alcohol diminishes the 
facility with which work is performed, is undeniable. In one of Dr. 
Parkes' series of observations, a soldier passed a period of three days per- 
forming a certain amount of work, without the use of brandy ; and, after 
three days of rest, another period of three days' work, with twelve ounces 
of brandy per diem, administered in four-ounce doses, at 10 a.m., 2 p.m., 
and 6 p.m. The man was requested to observe, as closely as he could, 
whether he did the work better Avith or without the brandy. He com- 
menced the brandy period, it is stated, with the belief that the brandy 
would enable him to perform the work more easily, but ended with the 
opposite conviction. The work done was chiefly performed in the two 
hours immediately succeeding each dose of brandy. The two hours' work 
after the first four fluid ounces appeared to be accomplished equally well 
with or without the brandy. The man, it is said, could tell no difference, 



except, to use bis own words, "the brandy seemed to give him a kind of 

it, which made him think he could d _ .. when he 

came to do it. lie found he sa capable than be thought." A : the 

: ur ounces of brandy, at 2 p.m., he felt hot and thirsty, but on the 
- thought he worked as well as on the water days. On the third 
r, the rep :at he had palpitation of the heart, and was 

- I to find that he was obliged to stop from time to time, because of 
his breathing not being so good. The third four fluid ounces 
taken at >n all three days yery marked narcotic efi 

The account given is that "immediately after taking it, he became he 
feit the _ si lis ::ion to exert himself, and could hardly refrain 

from throwing down his spade and giving up his work. He worked with 
no vigor, and on the second evening thought his muscular power - 

asened. On the third evening it was raining; he could not dig, but took 

walking and running exercise under cover. On attempting to run. he 

found, to his great surprise, as he is a particularly fast and good rnnner, 

that he could not do so. He had palpitation, and got out of breath, and 

bliged to stop." 

I : cohol in improper quantities is habitually indulged in, all the impor- 
tant rgai s, nd almost every part of the body, are involved in the degenera- 
tive changes ; Dickinson aptly declares it the very -genius of deg ::>n. w 
The nature of these changes appears in all cases be fibi and fatty. 

The question now su^_ ?sts itself, is alcohol desirable as an article of 
food in health? In a moderate quantity, it appears to improve the 
appetite, and by stimulating the mucous membrane, it issists ligestion. 
It also increases the activity of circulation. This is. practically, the limit 
of its useful!. — - Xxt in importance is to determine the largest quantity 
which can be conducive to health. Drs. Anstie and Parkes and Count 
.owicz made many experiments, with precisely the same results. They 
found that, in a stroug healthy man, accustomed to alcohol in moderati . 
the quantity given in twenty-four honrs that begins t r 

which can be considered injurious, is something between one fluid ounce and 
two fluid ounces. The limit, then, for a man of average strength, may 
properly be considered to be between one and one and one-half fluid ounces 
in twenty-four hours, before the entrance into that stage in which the 
son ous effect of alcohol becomes maniie— :. While some persons might 
v take slightly larger quantities continuously without injury, there are 
many in whom a less amount would be required to produce bad eti 

The estimate is made for pure alcohol, the principal constituent : 
alcoholic bev _ One ounce is equivalent to two ounces of br; 

five ounces of the strongest wines (sherry, etc.), ten ounces of the weaker 
wines (clarets), and twenty ounces of V j standard is fairly c :eet, 

if, as assumed, the beverages are pure. The fact that many of them are 
made up of baser ingredients should not be forgotten. 



ALCOHOL. 5 1 

Since alcohol is undeniably hurtful in large quantities, is it not so in 
smaller amounts? Does it contribute to health, vigor, and long life? [f 
the moral considerations are excluded, these questions cannot be settled by 
scientific facts alone. Dr. Anstie, in his work on "Stimulants and Nar- 
cotics," says: "Nor is the use in everyday life of these substances an 
outgrowth of modern corruption; on the contrary, it is consecrated by 
whatever sanction immemorial custom can confer. There is absolutely no 
period in history, as there is absolutely no nation upon earth, in which we 
do not find evidences of this custom." Regarding the argument that the 
universality of the habit of using some intoxicating drink proves utility, 
Parkes says: "This seems incorrect, since whole nations (Mohammedan 
and Hindoo) use no alcohol or substitute ; and since the same argument 
might prove the necessity of tobacco, which, for this generation, at any 
rate, is clearly only a luxury. The widespread habit of taking intoxicating 
liquids merely proves that they are pleasant." 

Regarding the inference of some, that alcohol, if not necessary in 
healthy modes of life, is so in our artificial stage of existence, amid the 
pressure and conflict of modern society, the same author further adds : 
" This argument is very questionable, for some of our hardest workers and 
thinkers take no alcohol. There are also thousands of persons engaged in 
the most anxious and incessant occupations, who are total abstainers, and, 
according to their own account, with decided benefit." 

The question has been asked, If alcohol causes disease, may it not also 
prevent it? There is certainly some reason to believe that this agent has 
an influence in lessening the liability to consumption, when moderately 
used. The experience of the writer confirms this belief. In an extended 
practice among the Germans, habituated to beer-drinking, he learned that 
they were surprisingly exempt from this fatal pulmonary disorder. This 
fact led him to advise the use of alcohol, in some form, in all cases where 
there was reason to believe the lungs were threatened by the disease, or the 
first stage of the same had been entered. The result of this treatment has 
been such as to warrant its continuance. In presenting the almost univer- 
sal beer-drinking habit of the Germans as an illustration of the preventive 
influence of alcohol on disease, the question is pertinent, Can this action of 
beer be attributed to the stimulant properties, or is it due to the nutritive 
principles which that beverage is known to possess ? Its nutritive value 
cannot be overlooked, and that it contributes to bodily support is an 
evident fact. As a nourishment, it is, doubtless, influential to a marked 
extent in excluding consumption; but to assume that the alcohol which it 
contains is still more active, seems justified. 

That millions of persons use spirituous liquors in moderate quantities 
without appearing to suffer any injury, and that many are actually bene- 
fited by them, are facts presented to sustain the theory that they are desir- 
able articles of diet in health. This is a strong argument, but by no means 



52 ACCESSOR? POODS. 

a conclusive proof. That such a large part of the human race could have 
wrongly attributed great dietetic value to an agent of such little use in 
small quantities, ami so fatal to health in large, seems at first impossible, 
ami vet acceptation, no matter how universal, is not convincing evidence 
of truth. 

In man's unusual experiences, when forced to endure the extremes of 
cold or heat, the want of food or the hardships of war, all observers have 
condemned the use of spirituous liquors. Dr. Hayes said that he would 
not only not use spirits, but would take no man accustomed to use them. 
All other Arctic explorers were unanimous in their prejudice, born of ex- 
perience from the most trying exposure to intense cold. That alcohol is 
even more hurtful in the hottest climates, ample testimony has been given 
by the best authorities. 

It is generally considered that when there is a want of food, alcohol 
has a sustaining force, and maintains the activity of the heart. That it 
lessens the waste of bodily tissues has not been proved. That a man de- 
prived of food can live a longer time if allowed wine and sjmits than he 
would were he denied them, is not believed. 

The belief that rations of spirituous liquors should be daily served to 
the soldiers and sailors subjected to the exposures and exertions of war, 
has long since been proved a mischievous delusion. Dr. Mann, an Ameri- 
can surgeon in the war of 1813-14, wrote thus : "My opinion has long been 
that ardent spirits are an unnecessary part of a ration. Examples may be 
furnished to demonstrate that ardent spirits are a useless part of a sol- 
dier's rations. At those periods during the Revolutionary War when the 
army received no pay for their services, and possessed not the means to 
procure spirits, it was healthy. The Fourth Massachusetts regiment, at the 
eventful period when I was surgeon, lost in three years by sickness not 
more than five or six men. It was at a time when the army was destitute 
of money. During the winter of 1779-80 there was only one occurrence 
of fever in the regiment, and that was a pneumonia of a mild form. It 
was observable in the last war, from December, 1814, to April, 1815, that 
the soldiers at Plattsburg were not attacked with fevers as they had been 
the previous winters. The troops during this period were not paid, — a 
fortunate circumstance to the army, — arising from want of funds. This 
embarrassment, which was considered a national calamity, proved a bless- 
ing to the soldier. When he is found poor in money, it is always the case 
that lie abounds in health, — a fact worth recording." 

A- to the effect of alcohol on increasing or diminishing the facility 
with which bodily labor is performed, an experiment has already been 
given as an illustration of its uselessness. That it increases mental power 
is not believed. It may for a time, by its influence on brain-circulation, 
renew activity lessened by fatigue and close application; and that, by the 
creation of fancies, light mental work may be made easier, is not impos- 



ALCOHOL. 53 

sible. If, however, the effort demands deep, clear, and continuous reason- 
ing, the strength of the mind will be lessened by the use of alcohol. 

It has been said that the general opinion in New Orleans and Mobile- 
is that the victims of yellow fever are chiefly those who drink freely. 
During the late rebellion the writer was stationed in the West Indies, 
and he had considerable experience in this dread disease. While serving 
on the United States steamer Alabama, yellow fever broke out at Key 
West, and for some five weeks the fatality was terrible. At the end of 
that time, the vessel was ordered to proceed to Portsmouth, X. II., it 
being thought that in northern latitudes the scourge would be checked by 
cold weather. Although there were some one hundred and seventy-five 
men when the disease first appeared, when they reached New York harbor 
there remained so small a number unattacked, the steamer could be worked 
no further, and the quarantine officer was forced to send his boat's crew 
aboard to assist in keeping the boiler-fires burning until she could make 
an anchorage. Those men accustomed to an intemperate use of spirituous 
liquors were generally the first attacked by the fever, and few among 
them ever recovered. The survivors, with but few exceptions, were either 
abstainers, or rarely indulged in spirits, and never to excess. When the 
disease broke out, the writer took his place in the so-called "sick bay,'' 
the ship's hospital, and passed days and nights with the sufferers, eating 
and sleeping among them for six weeks, until they were at last removed to 
the hospital ship, and yet he escaped the fatal malady. He employed no 
preventive means, — none would have availed him ; coffee and tea were freely 
indulged in — otherwise he was strictly temperate. Not only were those 
men who were addicted to the use of spirits the first to succumb to the 
disease, but it also attacked men who through fear indulged immoderately. 
The steamer lay at Cape Haytian, San Domingo, for a short time, and 
those who died there were buried on shore. One day the launch's crew 
deserted the officer in charge, and, after entering a liquor shop, barricaded 
the door. They drank deeply, some even to insensibility, and only one 
could go aboard without assistance. Within forty-eight hours all but 
that one were delirious with the fever, and, if memory is not at fault, he 
who refused drink alone escaped death by the fatal "black vomit." 

It is a fact well known to physicians that even in the so-called moder- 
ate drinker there is an impairment of vitality. In certain diseases, in es- 
timating the chances of recovery, a consideration of the patient's habits is 
of no little importance. A strictly temperate man often throws off disease 
which would prove fatal were he habituated to the use of spirituous liquors. 
In pneumonia, typhoid fever, and many other severe acute affections, life 
depends much on the reactive powers. The surgeon knows full well that 
the possibilities of success in severe and capital operations are immeasur- 
ably increased if the sufferer is a stranger to the use of intoxicants. An 
abstainer might lose both limbs by amputation and live; the one given to 



- - »RY FOODS. 

the excessive use of strong liquors often snccnmbs to an insignificant 
wound. This fact should be carefully weighed, and a certain sense of 
security will compensate somewhat for the self-denied imaginary pleasure 
of the cup. 

Thus far. the discussion as to the desirability of alcohol as an article of 
diet has been confined to its physiological effect upon the system. Scien- 
tific facts have been presented, testifying alike to its merits and uunti ess 
the purpose has been to treat the subject impartially and fairly. After 
this careful consideration, no other conclusion can be reached than that 
the dietetic value of alcohol has been much overestimated. The extrava- 
gant assertion that it is invariably hurtful cannot be sustained ; neither can 
it be condemned altogether as an article of diet. There are conditions in 
sickness and in health when its use is desirable. Still, in good health it is 
not a necessity, and by far the majority of mankind could be better with- 
out it. All must appreciate the difficulty of limiting the use of alcoholic 
beverages to moderation. "Tis but a step from safety to danger, and the 
power to res:- ss is lessened as indulgence becomes habitual. 

A word to the many self-styled moderate drinkers, who, by restricting 
themselves to four or five drams each day, feel that they are escaping the 
noxious effects of excess. They are the most certain victims to alcohol ; 
for them there is infinitely greater danger than for the toper who indulges 
in his periodical bouts of riot, but abstains from spirits during the intervals 
between them. 

It now remains to consider the moral effects of alcohol, and they are 
>vious to all, it is unnecessary to devote much space to their discus- 
sion. It has been said that the misery it produces is so great that, were it 
unknown, half the sin and a large part of the poverty and unhappiness in 
the world would disappear. This is no exaggeration; it is the plain, 
simple, unvarnished truth. The statement admits of no modification. The 
horrors of intemperance can never be pictured ; the utter despair and deso- 
lation which attend it, no pen can describe. The weight of this great 
social curse falls, not where it can be most easily borne, but upon poor, 

'-: women and innocent children, — on the wives and the offspring of 
those pitiful libels on man, the drunkards. Few better than the physician 
know the extent of bitterness entailed, — the mental anguish, the suffering, 
and the fatality, — which can rightfully be attributed to the habit of intoxi- 
cation. Page upon page might be devoted to this subject ; and yet for 
what purp Be! Entreaty and expostulation would alike pass unheeded. 

I- there not a remedy for this evil, — this malignant disease, which 
destroys so many thousands yearly ? Prohibitive legislation cannot cure, 
nor even arrest it; denunciation, no matter how extravagant, will not 
affect even one of the many symptoms. The work of reform is with the 
people, among themselves, and toward the progress of temperano - . 
man can contribute. 



ALCOHOL. 55 

The first step that would seem to promise advancement would be to 
enact a law, and put upon the adulteration of alcoholic beverages the 
severest penalty, in keeping with that already in force for the; administra- 
tion of poisons, among which fusel-oil, the principle of cheap fermented 
liquors, should be included. Intoxication should be more severely pun- 
ished, the term of imprisonment long, and, as Chambers says: "Habitual 
intoxication might justly be made a ground for dissolution of marriage, in 
that a wrong is done the nation, as well as to the innocent partner, when 
it is burdened with members incapable of contributing to the common 
weal, which is so likely to be the case with the progeny of drunkards. 
When the wrong is involuntary, we pardon it; but alcoholism cannot 
plead that excuse, unless it takes its stand on the ground of insanity, 
which removes the question into another category altogether. Those who 
claim the rights of free agents must answer for all the consequences of 
their acts." 

The substitution of beer and light wines for the stronger spirituous 
liquors should be encouraged by adjusting taxation, the burden being- 
placed upon the sellers of the latter. Societies devoted to the cause of 
teetotalism would do well to be more liberal, and, by a modification of 
their radical doctrine, aid in this substitution. History proves the wisdom 
of such a course, for, according to reliable authority, before the introduc- 
tion of native wines, when the stronger alcoholic stimulants were used, 
drunkenness was very common in California. The native wines are now 
found in nearly every household; they have supplanted, to a great extent, 
the use of the stronger alcoholic drinks. It is a fact, which no one famil- 
iar with California for the last twenty years will deny, that drunkenness is 
much less common now than formerly. This change is undoubtedly due 
to the substitution of the wines of the country for the stronger alcoholic 
stimulants. 

If a more extensive sale of wholesome and inoffensive drinks, such as 
tea and coffee, were encouraged, no little benefit would result. Were they 
as easily obtained as spirituous liquors, even the debauchee would often 
seek them in preference to his morning dram. They say : " Wipe away 
all poetry, all refinement from the cup, and it will cease to tempt." This 
is not true. Far better that the low grogshops and vile dens should be 
closed, and the sale of spirits be dressed with an elegance which will 
suggest the observance of civilities and decorum. It has been truly said 
that " as long as a sensual pleasure is coarse and rude, it can be attractive 
only by its quantity, and all indulgence can only be excess. The sensuality 
of the savage is selfish, shameless, and unbridled. With the advance of 
manners, it first parts with its selfishness, then it acknowledges the evils of 
excess, and then curbs itself more and more, till it ceases to be intemper- 
ance at all. True of other gratifications of instinctive desire, this is 
especially true of drinking." 



56 ACCESSORY FOODS. 

Let every municipal government provide, for the laboring man espe- 
cially. Borne public place or resort, where, surrounded by the refining influ- 
ence of works of art or nature, he can, when freed from toil, pass the few 
hours allotted him with his wife and children in harmless enjoyment. 
Above all, at the gardens or resorts, let him listen to music, that agent which 
rests weary limbs, lightens burdens, and touches the chords which bring 
in response all the finer sensibilities of man's nature. At these places let the 
authorities permit the sale of beer and light wines, and encourage also that 
of tea and coffee, and other harmless drinks, but strictly prohibit strong 
fermented liquors. The voluntary association will encourage temperance, 
it will be a step in self-education. The better element will hold in restraint 
those of baser promptings, and correct communication will foster propriety 
of behavior. Thus let the habit of drinking be stripped of all that is 
coarse and vulgar, let it be open as the day, and associated with delightful 
and refined memories. Then, and not until then, will moderation become 
a law of its existence. Who can doubt that the improvement of the 
human race will be continuous, and that, some time in the future, alcohol 
will yet be deprived of much of its evil, its influence upon health be better 
understood, and more properly applied? 

It remains to consider what treatment of the confirmed inebriate 
promises the best results. The inefficaey of persuasion has long since been 
proved. The fine sensibilities are so blunted by the action of alcohol that 
manly promptings and moral force soon become extinct, and there remains 
only the gross, sensual, animal instincts. Utter selfishness is one of the 
most prominent characteristics of the drunkard; the prayers of the heart- 
broken wife and the cries of his starving children alike fall on listless ears. 
He has but one thought, and that is to gratify his own shameless lust for 
strong drink. Expostulation is perfectly useless, and reform, without 
changed surroundings, is impossible. This inhuman blot upon society, this 
cancerous ulcer, which, by its corrosive action, destroys the happiness and 
even the lives of innocents, demands the most radical treatment. It 
should be removed, cut out, as it were, ere its fatal work can be completed. 
Fines and short terms of imprisonment are purposeless; but if confined 
until his body is entirely freed from alcohol, and his impoverished blood is 
again restored to its integrity, and the nervous system renews its strength, 
then for the inebriate, returning to the world with a healthier body and a 
sounder mind, there would be some hope of reformation. 

TOBACCO. 

Tobacco is one of the articles which, while not indispensable to nutri- 
tion or life, have yet been so generally used throughout all historic time, 
and all so rapidly extending their use, they may properly be acknowledged 
as a part of man's food. It is therefore appropriate that its consideration 



TOBACCO. 57 

follow that of alcohol. The subject is one which is generally treated in an 
eminently partisan manner, and exaggerated assertions arc too often 
made to sustain the force of argument. In discussing the tobacco habit, 
prejudice should be excluded, and both sides of the question carefully 
studied. 

In the United States Dispensatory it is stated that tobacco, when 
moderately taken, quiets restlessness, calms mental and corporeal inqui- 
etude, and produces a state of general languor or repose which has great 
charms for those habituated to the impression. In large quantities it gives 
rise to confusion of the head, vertigo, stupor, faintness, nausea, vomiting, 
and general depression of the nervous and circulatory functions, which, if 
increased, eventuates in alarming and even fatal prostration. 

The essential properties of tobacco are sedative and narcotic, emanating 
from the poisonous principle, an oil called nicotine. In smoking, the 
three points to be considered are, the local effect from the oily vapor from 
the burning leaves, the immediate effects, and the secondary effects. 
There can be no question but that the inhalation of smoke induces disease 
of the mucous membrane with which it comes in contact. It will produce 
a catarrhal state of the nose and throat when none exists, or it will awaken 
a new one in a patient who has been cured of the disease. The immediate 
effect of smoking may be stimulating, sedative, or narcotic, according to 
the quantity of nicotine introduced into the system, and the peculiar sus- 
ceptibility of the smoker to the influence of that agent. The secondary 
effects are generally gradually felt, and, as has been said, " a man may 
exhaust the strength of his nervous system and lower its tone, or he may 
impair his digestion by habitual excess in smoking." 

A series of experiments has been recently conducted by Herr Kissling, 
of Bremen, with the view of ascertaining the proportions of nicotine and 
other poisonous substances in the smoke of cigars. His paper, in Dinglers* 
Polyteclinisclies Journal, gives a useful resume of the work of previous 
observers. Only a small part of the nicotine in a cigar is destroyed by the 
process of smoking, and a relatively large portion passes off with the 
smoke. The proportion of nicotine in the smoke depends, of course, 
essentially on the kind of tobacco ; but the relative amount of nicotine 
which passes from a cigar into smoke depends chiefly on how far the cigar 
has been smoked, as the nicotine contents of the unsmoked part of a 
cigar are in inverse ratio to the size of this part, — that is, more nicotine, 
the shorter the part. Evidently, in a burning cigar, the slowly advancing 
zone of glow drives before it the distillable matters, so that in the yet un- 
burnt portion a constant accumulation of these takes place. It would 
appear that, in the case of cigars that are poor in nicotine, more of this 
substance, relatively, passes into smoke than in the case of cigars with 
much nicotine ; also that nicotine, notwithstanding its high boiling-point, 
has remarkable volatility. 



ACCESSORY FOODS. 

An evident conclusion is that it is loss injurious to smoke cigars than 
pipes, and cigarettes are decidedly the most noxious. Only two-thirds of a 
cigar, however, should be indulged in, as the last third contains the poison- 
OUS principle which will be given off in the smoke. 

In 1^ S J, the Boston Medical and Surgical Journal contained an edito- 
rial on the use of tobacco. Of the tobaceo-chewer it said: "He is, we 
fear, indigenous to our own country, a product of American soil. We 
have occasionally seen some old man who enjoyed a harmless quid and was 
the happier for it, and his neighbors none the worse; but the average 
American chewer, with hydra-mouth, who penetrates into every phase and 
aspect of public life, is a national disgrace. As great as this evil still is, 
however, we believe that it has already lessened, and will continue to grow 
less as soeial refinement becomes more widespread. 

'•Our greatest danger now seems to be from the excess of cigarette- 
smoking. The number of young men who smoke cigarettes is almost 
startling. It is not only students, but even school-boys in their teens, who 
vigorously and openly indulge in this dangerous habit. We very well 
remember that we ourselves experimented on a 'short six' at the age of 
sixteen, but this was done in the greatest seclusion, in the depths of the 
back pasture, and several hours were allowed for fumigation before calling 
on our friends and family. At that time, we should not have dared to 
smoke in public before the age of twenty-one. The times hare changed 
now, and boys begin to smoke when young, and the introduction of cigar- 
ettes seems partly accountable for this change. A little cigarette, filled 
with mild tobacco, which lasts for only a few minutes, appears harmless 
enough. But the very ease with which these bits of paper can be lighted 
and smoked adds considerably to the tendency to indulge to excess. Then, 
too, young men and boys, with vigorous and partly developed bodies, do 
not feel the bad effects of tobacco, which, nevertheless, will eventually tell 
on the vitality of the nervous system, and, feeling no immediate bad 
effects, smoke on ad infinitum. 

" The dangers, then, which are incident to cigarette-smoking are, first, 
the early age at which it is taken up ; second, the liability to excess ; and, 
third, the bad custom of inhaling the smoke. These are dangers super- 
added to those attendant on the ordinary use of tobacco, and should be 
carefully considered by all medical men." 

Of that most pernicious fashion of inhaling cigarette-smoke, the London 
Idtncet says : " The smoker who draws the greatest amount of smoke and 
keeps it longest in contact with the lining membrane of the air-passages, 
undoubtedly takes the largest dose of the oil." 

Cigarettes probably make a more lasting impression upon the system 
than cigars, and are harder to renounce. There is a popular impression 
that the principal injury comes from the paper containing the tobacco. 
This is not true. In cigarette-smoking the vapor is inhaled, and, coming 



TOBACCO. 59 

in contact with the delicate mucous membrane of the air-passages, its 
active properties are at once absorbed, and produce an immediate effect, 
which can be perceived to the tips of the fingers. The succeeding sensa- 
tion is one of ennui, malaise, indolence, and muscular hebetude, which soon 
becomes burdensome, unless the stimulation be renewed and prolonged by 
a fresh cigarette. 

The use of tobacco among boys in the educational institutions of the 
United States government has attracted the attention of the surgeons in 
charge. It is said that an energetic opposition to this practice is being 
made, for instance, in the Naval Academy, at Annapolis, and the United 
States Military Academy, at West Point. The naval surgeons, and espe- 
cially Dr. Gihon, U. S. N"., have been the principal movers in the opposition, 
alleging that tobacco (1) leads to impaired nutrition of the nerve-centres ; 
(2) is a fertile cause of neuralgia, vertigo, and indigestion ; (3) irritates the 
mouth and throat, and destroys the purity of the voice; (4) produces 
defects of vision ; (5) causes a tremulous, hard, and intermittent pulse ; 
(6) develops conspicuously irritability of the heart; and (7) retards the 
cell-change on which the development of adolescence depends. 

In 1883 it was reported that a lad employed in a lawyer's office in 
Brooklyn became so addicted to smoking cigarettes and chewing tobacco 
that he died of narcotic poisoning. 

It is doubtful if a single physician at all familiar with the subject 
will differ from Dr. Witter in his statement that beginning the use of 
tobacco in early life cannot be too strongly condemned, as producing most 
pernicious effects upon the constitution of the young, and as impairing 
greatly, if not wholly destroying, the chances of success as students and 
scholars. Tobacco should never be indulged in before the age of twenty- 
one is reached, and might more wisely be delayed until the body has 
become fully and completely developed. 

It now remains to consider the effect of tobacco upon adults. That 
regular indulgence in it is productive of great pleasure to many, is a fact 
which cannot be questioned. The majority of physicians who, from per- 
sonal experience, are familiar with the physiological action of the substance, 
when consulted upon the subject, will advise the inquirer that, if he has 
never used tobacco, he most assuredly ought not contract the habit of 
smoking. This easy solution of the problem cannot be reached in all in- 
stances. If a man has long indulged moderately and found no evil effects 
from its use, and it has unmistakably added to his comfort and pleasure, 
then there is no apparent need of depriving him of what is a comparatively 
harmless enjoyment. It is a common custom in referring to this subject 
to make the abuse and the use of the substance synonymous. Because it 
is injurious to some persons, it is not essentially so to others, and general 
rules applicable to all cannot be established from limited individual expe- 
rience. A moderate use of tobacco may unquestionably be continued for 



60 ACCESSORY FOODS. 

a long time, and probably indefinitely, without harm. There are few 
people in adult life who would derive any injury from three cigars daily, 
but the danger conies from the fact that the number is more often in- 
creased. 

Tobacco has an action in common with tea and coffee; it enables men 
to endure hunger, cold, hardship, and privation, better than they could 
without its aid. Upon those who arc active and given to great muscular 
exertion, the injurious effects of this substance are less than upon others 
confined to sedentary occupations. In determining the limit of modera- 
tion within which the tobacco can safely be indulged in, each individual 
should carefully study its effects upon his system, and not be governed by 
the experience of others. An understanding of the symptoms excited 
by over-indulgence will aid him largely in escaping the noxious influences 
of the substance. 

One of the most common disorders resulting from the excessive use of 
tobacco is a nervous weakness of the heart. In such cases there is no 
actual disease of the structure of that organ, but the functional disturbance 
is sometimes of grave intensit}^. This affection, appropriately termed the 
" tobacco heart," was common among the soldiers in the late American 
war, as nearly all of them were given to immoderate smoking. 

There is no proof that digestion is benefited by the use of tobacco, 
as is popularly supposed, but, instead, it is safe to assume that this process 
is disturbed by over-indulgence. The effect of an excessiv-e use of the 
substance on the nerves is decisive; the nervous system is weakened, and 
the disposition is rendered irritable if not morose. That to the poisonous 
action of nicotine certain mental diseases can be rightfully attributed, is an 
accepted fact. Forms of insanity may be induced by this agent alone, 
but more often the noxious principle acts with other and combined influ- 
ences in producing the derangement. 

The conclusions which are to be deduced from the foregoing study of 
the action of tobacco on the human system are that it is unnecessary to 
health, but pleasing to the senses when once the habit is acquired. Its 
excessive use is sinful, and productive of much evil. For those who 
learn to smoke late in life, or, at least, not until after maturity is 
reached, a moderate indulgence can be productive of but little if any 
injury. 

The so-called " anti-tobacconists " too often entangle themselves in that 
fatal snare, exaggeration. They denounce tobacco as always a poison, and 
even its temperate use a sin. Thus their efforts have been retarded, and 
the social good which they might have accomplished has been destroyed 
by being tied in the same bundle with prejudice and fallacy. They seem 
to forget that tea and coffee, articles of food doubtless as acceptable to 
them as to others, contain active principles which are capable of producing 
poisonous effects upon the system if taken in excess. Is it not pertineut 



TOBACCO. 61 

to ask those well-meaning people if they are consistent, and if they invari- 
ably practise temperance in eating and in drinking the beverages so gener- 
ally accepted as harmless? The habitues of tobacco can never be influ- 
enced by wild and extravagant assertions; their ranks arc filled not from 
the ignorant classes alone, but among them are many of the most intelli- 
gent men of the age, who can only be reached by arguments based on 
facts, not on fancies. 

An occasional cigar can be productive of no greater injury to the 
system than a cup of strong tea. The immediate effects are soon dissi- 
pated by the renewing changes which are constantly going on in the 
body. If a sufficient period elapses before a second indulgence, all trace 
of the first will have disappeared. If, however, this interval is not allowed, 
or is shortened, then the noxious principle begins to accumulate and de- 
rangement commences. 

Those people who suffer from catarrhal inflammation of the throat 
should be very temperate in the habit of smoking. Deafness due to 
this affection of the mucous membrane is aggravated by the oily vapor 
of the burning tobacco. Singers jeopardize their purity of voice by smok- 
ing, and cornet-players lose their "lip control" if they indulge the habit 
too freely. Literary men, and others confined to sedentary occupations, 
cannot safely use as large an amount of tobacco as those employed at 
active muscular labor, as exercise in the open air ^n'oniotes a speedy 
elimination of its effect. 

It has been claimed that smoking induces bronchial and pulmonary 
affections. This is not true; the oldest specialists have failed to find a 
case where disease of the lungs or their passages could properly be laid to 
the influence of tobacco. 

The form in which tobacco is used is of no little importance for smok- 
ers to consider. Cigars are better than pipes, and either is preferable to 
cigarettes. A pipe should not be used indefinitely, as it becomes loaded 
with nicotine after a short time, and is then positively injurious. Pipes 
with short stems, especially those made of clay, are dangerous, as cancer 
of the lower lip often results from their use ; pressure and heat are the 
most active agents in inducing this disease. Sufficient reference has 
already been made to cigarettes to show that physicians almost unani- 
mously consider them abominations. 

The habit of smoking should always be held in restraint, for tobacco, 
as with many other substances employed and consumed by man, is harm- 
less when rightly used, but it can by excess be converted into an instru- 
ment of danger. The youth are essentially lacking in self-restraint; theirs 
is an age given to immoderation, and for them tobacco should be strictly 
forbidden. The injurious effects on adults which characterize the exces- 
sive use of this substance are more marked and intensified in the case 
of the youthful indulger. 



62 A.CCESSOKE FOODS. 



CANNED FOODS. 

Within the past fow years the canning of foods has become an industry, 
especially in America. This process of preservation by the exclusion of air 
is one' of the most efficient now in use, and, when properly performed, the 
provisions enclosed in cans will remain for years in a perfectly good and 
sound condition. Its advantages cannot be over-estimated; fruit and vege- 
tables, changed but little from the fresh state, can now be had at all seasons 
of the year, and in all localities. The pecuniary advantage of being able to 
obtain such a variety of food, wholesomely preserved, is also an advantage 
of no little importance. The flavor of canned substances is but slightly 
affected by the process, excepting that of meat, which, while it retains all its 
nutritive value, yet acquires a peculiar taste from over-cooking, deemed 
necessary to destroy all germs and insure preservation. 

From time to time, cases of poisoning by canned foods have been 
reported, and doubtless some were properly attributed to that cause. It is 
also reasonable to suppose that in others too much was assumed, and the 
preserved foods were wrongfully charged with the fault. In all fairness, 
exaggeration should be carefully avoided, as it will be easy to preju- 
dice the use of foods now of great dietetic value, impute unmerited 
blame to honest manufacturers, and threaten an important branch of 
trade. 

Of the safety of canned foods, the Boston Medical and Surgical 
Journal says : " A sufficient number of instances of poisoning from the 
consumption of canned foods continue to be reported from time to time, 
from various parts of the country, in the daily press, and at times under 
cover of a certain degree of medical sanction, to seriously interfere with a 
very important American industry. We do not doubt that many of these 
reported cases are greatly exaggerated, and that in a still larger number, 
whether exasperated or not, something else than canned food, which is 
now so readily accused, is really guilty of the effects observed. It is one 
thing for a physician to pronounce a case to which he may be summoned 
one of poisoning; it is quite another, and often far more difficult, thing to 
designate the precise article at fault; and before incriminating any indi- 
vidual substance, too much care cannot be exercised upon a thorough 
examination of all the premises, — especially where such substance happens 
to be an article of daily consumption, for which, in some parts of the 
country, it would be difficult, if not impossible, to provide an equally satis- 
factory substitute. 

"There are no food products, whether in the fresh or preserved form, 
which may not at times be met with in an unwholesome state, but we 
believe the preserved forms are really less frequently poisonous than the 
so-called fresh forms. Notwithstanding the vigilance of food inspectors 
in our large cities, there can be no doubt that no inconsiderable quantities 



CANNED FOODS. 63 

of 'fresh' meats, fruits, and vegetables unfit for consumption escape detec- 
tion, and go into use among some classes of the population. The instances 
in Europe where large numbers of partakers of fresh meat from diseased 
animals have been seriously and fatally poisoned thereby arc by no means 
few. The average annual production of canned foods in the United States 
is now estimated to be upwards of 500,000,000 of tins, or about ten for 
every inhabitant of the country. It is not alone a great article of 
commerce at home and abroad, but, as we have remarked, furnishes a 
cheap, transportable, and indispensable food-supply, in many places and 
under many circumstances. It is frequently not a question between fresh 
roast beef or mutton and canned meats, but between these latter and 
smoked or salted meats ; not a question between fresh or canned vegetables 
and fruits, but between these latter and none at all. We are not arguing 
that the canned articles are as nutritive or as toothsome as the fresh, but 
merely that, with the exercise of ordinary care on the part of the consumer, 
the likelihood of being poisoned by the former is certainly as small as by 
the latter. The appearance of the head of the can is generally a pretty 
safe index to the condition of the contents. 

"Among other testimony as to the quality and reliability of American 
canned foods, Ave notice, very recently, that of Gen. J. P. Hawkins, Chief of 
Commissary, United States Army, who, during an extended experience of 
the use of such foods in a military department, never knew of a case of poi- 
soning, nor could he learn of any from inquiry of the Medical Director. 
A striking example of the keeping qualities of canned fish is found in the 
fact that the American canned salmon which was awarded the first prize 
at the Fisheries Exhibition in Berlin, in 1880, was packed in 1875, and had 
previously been exhibited, and took the first prize at the Centennial Exhi- 
bition, in 1876. The same permanency may be found in many other 
articles, when the can remains sound and has not been accidentally or pur- 
posely tampered with. Whilst desirous that those engaged in this impor- 
tant national industry should be protected from unjust suspicions and 
untenable charges, it is, as we realize, no less necessary that the more 
numerous consumers should be protected from fraud or injury; but we 
imagine the laws of trade are still quite competent for that end, without 
any medical or sanitary crusade." 

On the subject of poisoning by canned foods the same journal says : 
"His attention being called to the subject by the occurrence in his practice 
of six cases of corrosive poisoning, according to his diagnosis, from eating 
canned tomatoes, Dr. John G. Johnson, of Brooklyn, New York, inquired 
into the general question of poisoning by canned goods, and presented a 
paper on it before the Medico-Legal Society of New York, April 9 
[1884]. We reproduce the general conclusions of this paper, as an answer 
to some of the queries excited by our editorial comments of October 16, 
on the ' Safety of Canned Foods' : — 



64 ACCESSOR* FOODS. 

i The six cases wore not cases oi sickness from spoiled tomatoes. 
(2.) They were cases of corrosive poisoning from muriate of zinc and 

muriate of tin. (3.) Tins poisonous amalgam must be abandoned. (4.) 
Ei mplary damages, 'at the discretion of the jury,' will be sustained by 
the courts tor this reckless tampering with human life, in using a dangerous 
means, when a sate one could be used. (5.) The canners have only them- 
selves to thank for the present panic in their business, for they have per- 
- s 1 in this dangerous plan, knowing it was dangerous. (6.) Every cap 
should be examined, and if two holes are found in it, send the can at once 
to the Health Board, with the contents, and name of the grocer who sold 
it. (7.) Reject every article of canned food that does not show the line 
of rosin around the edge of the solder of the cap, the same as is seen on 
the seam at the side of the can. (8.) Reject eveiy can that does not have 
the name of the manufacturer or firm upon it, as well as the name of the 
company and the town where manufactured; ' standards ' have all this. 
When the wholesale dealer is ashamed to have his name on the goods, fight 
shy of them. (9.) Press up the bottom of the can ; if decomposition is 
commencing, the tin will rattle, the same as the bottom of the oiler of your 
sewing-machine does. If the goods are sound, it will be solid, and there 
will be no rattle to the tin. (10.) Reject every can that shows any rust 
around the cap on the inside of the head of the can. If housewives are 
educated to these points, then muriate of zinc amalgam will become a 
thing of the past, and dealers in ' swells ' have to seek some other occu- 
pation." 

FOOD ANTIPATHIES. 

That some people have an insuperable constitutional antipathy to 
certain kinds of food, is indisputable. It may be generated in a person 
who has suffered injury from some substance which previous to being 
eaten was not an object of dislike, and it may be a natural instinctive 
aversion which is felt in the presence of a particular article of food. 
The existence of an antipathy prompted solely by instinct must be 
accepted as an established fact, Avhich will admit of no explanation, and, 
as with many other phenomena, it can only be regarded as one of Nature's 
vagaries. 

The following extract from a long paper written by Mrs. Rose Terry 
Cooke for the Pittsburg Despatch well illustrates the subject under con- 
sideration. Says Mrs. Cooke: — 

"I once knew a young girl to whom the least particle of egg was poison. 
In self-defence, as well as out of regard to her hosts, she was always obliged 
to ask the ingredients of any dish set before her which might perhaps con- 
tain the obnoxious article. She could not drink coffee that was cleared 
with an egg; and once, going out to a tea party, she asked the lady of the 
house if she put eggs in her biscuit; she assured my friend that she had 



REMARKS on DIET. 65 

not, but no sooner had the unfortunate guest swallowed one mouthful of 
the light flaky roll than she went into a sort of spasm that quite broke up 
the party and alarmed all those about her. Her hostess explained that 
she had quite forgotten having put one egg into the dough that made 
three or four dozen biscuit, nor eould she have imagined that so iniiuitesi- 
mal a portion as was- conveyed in one mouthful eould have affected any 
one, but it did, and came very near being fatal. 

"At another time my friend was seized with similar symptoms, but 
could not trace a particle of egg in what she had eaten; indeed, she had 
not eaten anything since noon, as the day was warm and her appetite deli- 
cate from the languid weather, but it was afterwards discovered that some 
icing for cake had been made that morning in a large pitcher, as in those 
days, before Dover egg beaters were invented to bless us, it was the custom 
to beat icing with a knife in a deep cup or pitcher, and a lazy servant mak- 
ing lemonade had not washed the pitcher, thinking the little icing that 
remained after scraping out the utensil would not hurt the lemonade, but 
my friend drank some and was severely ill. 

" I have known many persons who could not eat veal. It is to me really 
poisonous, and I never have it on my own table ; but many times I have 
dined where veal was the only meat on the table, and been obliged to 
leave it untasted. I have another friend who cannot eat even one straw- 
berry without being ill. I had another on whom they brought out an irri- 
tating eruption. Several kinds of fish produce this effect on certain organ- 
izations. I had a relative who went into convulsions at the smell of cheese, 
and it was both amusing and irritating to a young niece, wdio travelled 
with him a good deal, to find it devolved upon her to inspect the table 
whenever he took any meal at a hotel, and order off this viand promptly 
and peremptorily. One day at a country hotel she was just in time to avert 
painful consequences, by seizing a plate from the waiter, who was about to 
set it down under her uncle's nose, and wdiisking it away below the table 
the other side, telling the astonished girl, in a veiled voice : — 

"'Take this cheese away directly, or that old gentleman will have a 
fit ! ' Fresh pork, too, is obnoxious to some people, and umvholesome for 
more. Apples, often recommended as wholesome for mind and body, are 
not so for every one. I have known two or three people who could never 
eat even one, and sometimes they excite severe colic." 

GENERAL REMARKS ON DIET. 

With wearisome detail the most common articles of food and their 
peculiar action on the system have now 7 been considered. The importance 
of the subject of diet justifies this careful study, as not only the health 
but also the happiness of mankind largely depends upon a wise selection 
and a judicious use of food. 



ACCESSORY POODS. 

It would be impossible to establish rules of living applicable alike to 

neither is it essential to health nor compatible with comfort to enforce 

re restraint. There are, however, certain laws, established by Nature, 

which cannot be violated with impunity, and a proper observance of them 

is the duty of all, to themselves and to their Creator. 

It is Dot to be assumed that because certain articles of food are easy of 
digestion, the diet should be restricted to them alone, and a rigid self-denial 
practised which will deprive eating of many of its charms: but it is reason- 
able to suppose that a man ought to confine himself within certain limits, 
and not wantonly violate the fixed laws of digestion. 

There are many substances admitted as food which, while pleasing to 
the taste, are yet so indigestible they could wisely be excluded. In certain 
morbid conditions of the system some articles of diet are forbidden which, 
in a healthy state, are no tax upon the stomach. Much also depends upon 
the preparation of food: cooking renders many substances easy of assimi- 
lation which, in their natural form, are almost impervious to the action of 
the digestive fluids. Combinations are effective ; some articles which alone 
are with difficulty acted upon, are by the influence of others rendered 
much less burdensome to the stomach. 

The reasons why man should educate himself to a proper understanding 
of his obligations to Nature are numberless; it must be accepted that to 
ignorance of them can be attributed much of the ill health and unhappiness 
which he is forced to experience. The peculiarities of self should be care- 
fully studied, and the digestive powers of each ought to be aceurately 
estimated. Appetites may be properly termed natural and artificial. 
Hunger and thirst illustrate the former ; they manifest the actual wants of 
the system. An artificial appetite is one acquired by continuous indulgence 
in substances which are at first displeasing to the taste, such as tobacco and 
certain articles used as food. It is often a morbid prompting, and submis- 
sion to it ought to be guarded. 

"Man, know thyself," is a wise admonition, and it should be deprived 
of none of its force when applied to the subject of dietetic government ; 
he should eat to live, not live to eat. There is a higher purpose in life than 
mere personal gratification. The first object of food is to nourish and 
sustain the body in the perfection of health. Let it be pleasing to the eye, 
tempting to the palate; dress it with all possible charms, consecrate the 
table a social shrine, sanctify it witli delightful memories ; but never forget 
its purpose and prostitute it by gluttony and wanton excess. 

Many persons attempt to deceive themselves and justify over-indul- 
gence in food, arguing that they merely eat until hunger is appeased. 
Rather do they load their stomachs to the utmost capacity, and only 
desist from sheer inability to swallow more. Such men at the table 
are twice satisfied, — first, when nature is properly supplied, after which 
they continue to eat, tempted by the pleasing appearance and flavor of 



TOTAL DEPRIVATION OF FOOD. G7 

food the system does not need, and which cannot be digested without 
laborious effort. 

In 1880 Dr. Tanner voluntarily subjected himself to a fast of forty 
days' duration. Before commencing the undertaking, he frankly invite 1 
espionage, courted the strictest surveillance, in fact, solicited and impor- 
tunated the medical fraternity of New York to appoint representatives to 
note his every act with constant vigilance. Whatever the motive of this 
man, whether he simply made the sacrifice for the benefit of science, or 
wdiether he intended it as an investment, thinking to acquire notoriety 
which would ultimately yield him as a lecturer a great pecuniary recom- 
pense, is a matter of conjecture. The extraordinary effort which he con- 
templated was entirely at variance with nature's laws ; it also promised a 
cruel self-infliction, against which humanity protested. Doubtless for 
these reasons the members of the medical profession declined to be iden- 
tified in any way with the experiment. 

Tanner passed through his period of privation, and apparently recov- 
ered his former vigor. Six years have since passed, and he is reported as 
enjoying unimpaired health. That he abstained from food during the 
entire forty days there is no reason to doubt. For him to have done so 
seems incredible, and yet, notwithstanding the most suspicious attention, 
surrounded day and night by watchers not in his own employ, but in that 
of others in no wise in sympathy with him, he passed the fortieth day 
without the appearance of a sign to indicate that he partook of food in 
that long period. 

It is not a matter of surprise that the world withheld, and the medical 
profession refused, belief that the experimenter in truth fasted that length 
of time. All known physiological laws protested against an admission ; 
acceptance was beyond the limit of man's credulity. In the absence of 
any proof whatever of dishonesty, and notwithstanding the evidence of his 
watchers that he had faithfully and honorably performed his undertaking, 
the subject was dismissed from the public mind as unworthy of belief. 
Such a decision seems neither liberal nor deserved. 

Considering the recent developments, the new facts proved by trials of 
endurance, is it impossible that the latent powers of man are not fully 
appreciated, and might not man, like some other animals, possess an 
inherent capability to sustain life for even many days without food ? 

On the fifth day of Tanner's fast, the Boston Herald deputized a 
reporter to visit the physicians in its vicinity, to learn their opinions as to 
whether or not it was possible for a man to be deprived of food for forty 
days and yet life be maintained. On the following day a report of the 
interviews was published, and only one physician had given an opinion that 
such an experience was within the limits of man's sufferance. The favorable 
opinion was rendered by the writer, who, on one other occasion, was thought 
demented, because he predicted that it was possible for a man to walk six 



3SORY ] 

hundred rail sed his ss imption 

ts performed on himself, and - ^ed absti- 

nence with which he was familiar while in the practice of his 

: Ufferent lengths. the 

He had lived tor week- en mouths, on pr: 

a 1 reduced h> 

irn more of man's endurance. T 

e foundation for his favorable opinion : they also enabled him 
redict with near approach the amount o: nner lo- 

privat 

The long fast, s -fully maintained to the fortieth _ have 

been conducted on a more scientific basis, with better results; wing tc 
usies and ^me irregularities, much of its significance lost. Still, 

it was felt by regular practitioners, if not by the It 

the medical world an entire new line of thought, and sn liferent 

mode of dietetic treatment in many diseases. With the usefu that 

were taught by the success of this trial, there wraa ilso administered a 
rebuke to the illiberality which made it easy to condemn that which old 
theories refuted. 

er wiU pardon this digression when ssm that 
of the writer is in keeping with the subject of die: i government. It 
must be acknowledged that many members of the human fa: heir 

habits and practices as regards eating and drinking, are incons 
nate. illogical, and reckless. Mot that of all animals man alone wl 
to himself is peculiar in his determination to dig his grave with his teeth. 
for aim*: sf i.aen of the animal kingdom will do that favor- 

able circumstances. But man has reasoning povr g facul- 

unerring in deciding right and wrong, the beneficial and the _ . 

and qualities of mind which find their highest and best use in infl 
ing him to the i restraint, an impulse unknown : 

animals. A horse, finding himself loose in the stable at night, 

the grain a:. gorge himself to death, and this will occur without 
reference to the quality of the animal, whether he be of pure blood or 
ignoble breeding. 



::-:z proper axotxt of food. 

That gluttony characterizes no small part of mankind is fact beyond 
rities are not wanting to support the assertion that nearly 
all persons eat more than nature la for her support 

able man, Dr. John C. W 
food is of primary consequence t ards the formation of a goo 
tion. Th imoii error in relation to it 

much food. Nature has given us organs n the 



PROPER AMOUNT OF FOOD. 69 



!■(• ;i 



presumption that, being called on for manual labor, we should requii 
large quantity of food. Muscular effort exhausts the strength and requires 
renovation by nutritious substances, but when the muscular efforts are 

small, the quantity of nourishment required is comparatively trifling; and 
if, in consequence of the appetite, a large quantity is taken, the result will 
be pernicious, directly or indirectly. Let those who are compelled to 
sedentary pursuits seasonably lay aside one-third of their ordinary \'<>n<\, 
and they will experience no loss of time in combating the horrors of 
dyspepsia." 

It is a well known fact that the inmates of penitentiaries, confined to a 
uniform diet, plain in character and cooked in the simplest manner, enjoy 
uninterrupted health. Those who enter shattered and diseased by vile 
habits and excesses, are generally effectually cured after a short residence 
there. 

The greatest thinkers, the giant workers, the men who are marvels of 
power and energy, are the simplest in their habits of eating. A large pro- 
portion of the infirmities of mankind can properly be attributed to errors 
of digestion, the result of gross indulgences at the table. Anthony Carlisle, 
in his essay on the "Disorders of Old Age," says: "When it is considered 
that many serious disorders are entirely occasioned by improper diet, and 
that in almost every disease the direction of diet is perhaps of equal im- 
portance with the prescription of medicines, it is blamable to neglect this 
potent recourse, and to rely on the unaided administration from the 
apothecary's stores of a few grains of materials, whose qualities are ill 
understood. The most numerous tribe of disorders incident to advanced 
life spring from the failure or errors of the stomach and its dependencies; 
and perhaps the first source of all infirmities of senility may be traced to 
effects arising from imperfectly digested food." 

The eminent English surgeon, James Johnson, said : "The wonderful 
power of the digestive apparatus to assimilate everything which air, earth, 
or ocean yields to the support of man, is a striking proof of the wisdom 
as well as the beneficence of our Creator. But it is most erroneous in prin- 
ciple and pernicious in practice to infer from this that, because we can eat 
all things, we therefore may eat all things with impunity. And here one 
of the evils of civilization becomes manifest. Not only is everything that 
can allure the sense or stimulate the appetite brought to view in congre- 
gated society, but the 'dishes tortured from their native state' are 
indulged in by those who, of all others, are least capable of digesting 
them. The ploughman, exposed at all seasons to the inclemencies of tin' 
skies, and strenuously exercising his voluntary muscles, might gormandize 
with safety on alderman's fare. But not so the citizen, however well 
trained to the school of Epicurus. His sedentary life, and a host of moral 
and physical circumstances around him, render it a matter of impossibility 
that repletion shall not succeed even an apparently temperate regimen ; 



70 ACCESSORY FOODS. 

and in reality this repletion, and the irregular states of plethora which 
thence result, characterize nine-tenths of the diseases of civilized life, 
though they assume the garb oi debility, and too often lead to the most 
erroneous and unsuccessful methods of treatment. 

"The evil consequences of repletion, or luxurious living, far exceed 
belief, or even the calculation of the physician; for they metamorphose 
themselves so artfully, and mask themselves so successfully behind unsus- 
picious forms and phenomena, that they are constantly undermining the 
constitution, deceiving the patient, and misleading the practitioner." 

The amount of food demanded for the support of the body in 
a perfect state of health varies with the occupation, sex, habits, climate, 
etc As one author says: "The best guide is generally found in the infor- 
mation afforded by the sensations of the individual. It is the universal 
conclusion of all who have directed their attention to the subject that the 
time to cease eating is that at which a feeling of comfortable satiety is 
reached. This, while it may be indescribable, is, nevertheless, not difficult 
of recognition ; although there may be still an inclination to eat on 
account of the pleasant sensations due to the agreeable flavor of the 
food, it should be resisted. At all times, to eat until a sense of discom- 
fort caused by distention of the stomach is reached, ultimately results in 
dyspepsia." 

While over-indulgence in eating is the fault of many, the underfed con- 
stitute a class of no inconsiderable number. It is largely made up of 
women, who feel that in bread and tea they find sufficient nourishment to 
satisfy the demands of nature. It is no matter of surprise that among 
them poverty of the blood, "weaknesses," feeble circulation, neuralgia, 
cough, constipation, headache, backache, and a variety of other symptoms 
are common complaints. 

To overcome these disorders physicians are generally consulted, and 
they too often rely on the action of iron, quinine, and other tonics, when 
they should insist upon a more generous diet, and exact the most rigid and 
literal obedience to fixed and precise rules in regard to the quantity and 
character of the food and the times of taking it. The futile use of medi- 
cine in many cases testifies to the weakness of the professional advice and 
the culpable indifference of the patient. 

An insufficient dietary in the growing youth prejudices the entire 
future, and is a potent agency in inducing ill health and imperfect develop- 
ment. Its consequences are frequently exemplified in school-children, 
seamstresses, shop-girls, and among the debutantes in society; although 
evil effects appear, also, at other periods of life, and in both sexes, still, 
inadequate nutritive support before maturity is more severely felt than in 
succeeding years. 



SELECTION OF FOOD. 71 



THE SELECTION OP FOOD. 



To sustain bodily health, mental vigor, and promote long life, a wise 
selection of the food, and temperance in its use, is one of the primary 
essentials. None of the pleasures of existence need be sacrificed in the 
proper observance of Nature's laws. She is not exacting, nor does she 
punish every little deviation; still, keeping within the bounds of modera- 
tion is consonant with her system as approved by experience. 

The instinct and experience of each individual must together determine 
his appropriate diet. If a mask could be invented which would fit every 
human face with the same accuracy, then a fixed rule could be established 
which would be applicable to all for the selection of their food. In a 
general way, it may be said that those articles should be chosen which are 
agreeable to the taste, nutritious, and easily digested. Nature has given 
to man, in common w^ith inferior animals, a sure guide to distinguish those 
things which are beneficial from those which are injurious; his instinct 
prompts him to seek the good and reject the bad. The appetite may be as 
safely trusted for a physical as the conscience for a moral guide, unless the 
one has been excited by unnatural stimulants, as the other is hardened by 
habitual wickedness. When the system becomes disordered and digestion 
is impaired, then experience lends its aid to instinct, and teaches what to 
avoid and what to accept as best suited for nourishment and support. 

There is reason to believe that the dietetic value of meat is very gen- 
erally over-estimated. Many people consider it almost the only food 
capable of sustaining nutrition and supplying muscular strength. That 
health and vigor can be maintained on a diet consisting solely of vegetable 
products has been proved by the experiments of many. Interesting obser- 
vations were made by Dr. Grey in the English prisons, the results of which 
led him to believe " that we possess conclusive evidence of the sufficiency 
of a diet from which meat is wholly excluded, and even of a diet consist- 
ing wholly of vegetable matter." 

When testimony is not wanting to disprove the popular fallacy that 
meat is absolutely essential to the maintenance of health, it is generally 
accepted by the best authorities that the use of animal food in a reasonable 
amount is most in keeping with the nature of man. It is generally 
admitted also by intelligent observers that immoderate indulgence in the 
use of meat tends to diminish intellectual activity. The laboring man, 
inured to great muscular exertion, suffers less from its excessive use than 
he of literary pursuits, whose success in life depends upon mental energy 
and brilliancy of thought. 

Temperance in the quantity, the selection, and variety of food is not 
the only consideration respecting diet. The simplest and most digestible 
food may be made burdensome to the stomach by inharmonious combina- 
tions. None of the principal ingredients of the "mince pie" of New 



i _ ACCESSORY FOODS. 

/and would, alone, be a tax upon the digestive organs, and they are in 
a form suitable for consumption. The composition is, however, one which 
few people can properly indulge in, as. in its ingenious preparation, spices, 

stimulants, ami other condiments impair its digestibility, and the covering 
of pastry renders it still more unwholesome. The testimonies of the 
stomach should prevail against the inclinations of the palate, and prevent 
discordant associations. 

The temperature of food is often too high; particularly is this the case 
with potatoes and tea and coffee, which are not uncommonly used when 
hot enough to interfere with digestion. Bread and butter can be tolerated 
with complete immunity, while hot buttered bread often provokes exasper- 
ating dyspepsia. Against sausages there is a popular prejudice, and, when 
eaten hot. discomfort generally results. If, however, they are served cold, 
digestion is much more easily performed. 

It should be remembered that water is an important constituent of 
food ; it is, indeed, the carrier of food into and through the system, and 
forms more than two-thirds of the whole body. There are many people, 
especially women, who do not drink a sufficiency of water to maintain 
health and unimpaired nutrition. As a consequence, the quantity of blood 
is diminished, and the body's strength is lessened. About two quarts of 
water are each day eliminated by the skin, lungs, and kidneys, and an 
equal amount should be taken, alone, in tea or coffee, or in other drinks, to 
make trood the average daily waste. Those people who are poorly nour- 
ished generally suffer from constipation, which is due to a want of liquid 
in the intestinal canal. Even when this derangement occurs among the 
well fed classes, free indulgence in water assists materially in effecting a 
cure. 

THE TIME FOR TAKING FOOD. 

That the food should be taken with regularity and at proper periods is 
almost as essential to the maintenance of health and a vigorous state of 
the energies as that it should be of a suitable quality and in wisely appor- 
tioned quantity. The prevailing custom of eating three times each day is 
doubtless prompted by instinct and sustained by experience. An ordinary 
meal is digested in about four hours ; the stomach should then be allowed 
a short period of rest. To conform to the precepts laid down, food should 
be taken during the day at intervals of about five or six hours" duration. 
That the fast be broken immediately on rising is important, as the system 
is necessarily weakened by the long abstinence which follows the last meal 
of the previous day. 

To dine heavily at midday is the custom of many; this habit is not nec- 
rily an improper one, but it has its disadvantages. It disposes to inac- 
tivity, and few can afford the time which should necessarily pass before 
returning to severe labor. It is therefore advisable, especially for those 



TIME FOE TAKING FOOD. 73 

busily engaged, that the second meal of the day be a lighter and less cere- 
monious repast, one that can be taken quickly and yet be sufficiently sub- 
stantial to sustain the energies during the interval which follows. 

Pavysays: "The error is often made of omitting to take food in the 
middle of the day, of only taking a biscuit, or something of equal insignifi- 
cance. There are many business or professional men who, after leaving 
home for their office or chambers in the morning, do not taste food, or, if 
they do, take only a minute quantity, until they return in the evening. 
Actively engaged all day, the system becomes exhausted, and they arrive 
home in a thoroughly jaded or worn-out condition. They expect that 
their dinner is to revive them. It may do so for a while, but it is 
only a question of time how long this system can be carried on before 
evil consequences arise. They begin to feel heavy, drowsy, and uncom- 
fortable after dinner; and no wonder, from the amount of food that it has 
been necessary to introduce at one time into the stomach to supply the 
requisite material for meeting the wants of the system, and also from the 
exhaustion of power produced by the work performed and the long absti- 
nence from food. Vigor is required for digestion equally as much as for 
muscular or any other action, and it is not to be expected that it can prop- 
erly proceed under the state that has been described. Added to these 
indications that the digestive power is not equal to the amount of work 
thrown upon it, evidences of disordered action begin to show themselves. 
The sufferer becomes dyspeptic, and the heart and brain may sympathize 
with the derangement. The physician is frequently encountering instances 
of the description I have depicted ; and, when advice is given that food in 
proper quantity should be consumed in the middle of the day, the usual 
answer is met with that if a luncheon were taken it would have the effect 
of rendering the person unfit for his business afterwards. It is a sine qua 
non, however, that the interval should be broken by a repast between an 
early breakfast and a late dinner, and no medical treatment will suffice 
to afford relief unless attention is given to this point. When once the 
alteration has been made and persevered in a short time, as much reluctance 
will be felt in omitting the luncheon upon any single occasion as was expe- 
rienced in taking it to begin with. Often, in cases where indigestion forms 
the chief complaint, will it be found to have arisen from some unwitting 
breach of the principles of dietetics, and thence it frequently happens that 
instruction of the dietetic precepts requiring to be obeyed for the mainte- 
nance of health will be all that is needed to set matters right." 

It is generally assumed as consonant with health that the principal meal 
should be taken between six and seven in the evening. When the labors 
of the day have been completed, and the cares and anxieties incident upon 
an active business life are for a time dismissed, then the mind, cheered by 
the pleasures of eating, renews its energies, shares in the social enjoyments, 
and thus exerts a potent influence which renders digestion easier and favors 
nutrition. 



74 ACCESSORY FOODS. 

Dr. Combo says: "Experience must have taught every one with what 
zest we sit down to enjoy the pleasures of the table, and how largely we 
incline to eat. when the mind is free, unburdened, and joyous, compared 
with the little attention we bestow on our meals when we are overwhelmed 
with anxiety, or have the whole energies of the mind concentrated on 
some important scheme." u Laughter," also, says Hufeland, of Berlin, "is 
one of the greatest helps to digestion with which I am acquainted; and 
the east om prevalent among our forefathers, of exciting it at the table 
by jesters and buffoons, was founded on true medical principles. In a 
word, endeavor to have cheerful and. merry companions at your meals; 
what nourishment one receives amidst mirth and jollity will certainly pro- 
duce good and light blood. " 

While a short and light nap after dinner can be safely indulged in, a 
sound and prolonged sleep tends to interfere with and retard digestion. 
Some theorists maintain that it is no breach of the principles of dietetics 
to eat heartily before retiring, and attempt to sustain their assumption with 
the reminder that the instinct of animals prompts them to sleep as soon as 
they have eaten. This reasoning is absurd, as there is in this respect no 
analogy between the brute creation and mankind which warrants an infer- 
ence that the habits of the former can be accepted as a standard to fix the 
customs of the latter. 

Experience teaches that to eat heavily before going to bed is unwise, 
and productive of evil consequences. It also counsels that at that time it 
is equally inadvisable for the stomach to be in a perfectly empty condition. 
Sleeplessness is frequently caused by hunger, and a tumbler of milk, if 
drank in the middle of the night, will often quiet restlessness and watch- 
fulness. If the appetite prompts one to eat before retiring, a small quan- 
tity of light food can properly be indulged in ; it will exert a tranquillizing 
effect, and dispose to sleep. 



CHAPTER III. 
PHYSICAL EXERCISE. 

Perfect health is dependent upon obedience to organic law. Man may, 
for a time, by physical transgressions, seemingly presume on mother Nature 
with impunity, and yet he deceives himself, for sooner or later he must 
endure the infliction of her penalty. 

Berchard has defined life as "organization of action." Perfect health 
may be said to exist if the organs of the body possess all their powers, 
faculties, or qualities entire and in full vigor, if their functions are com- 
pletely and harmoniously performed, and the simpler structures and fluids 
retain their normal integrity and essential properties. 

Physical exercise is indispensable to the preservation of health, and 
contributes alike to the happiness and intellectual vigor. Inactivity is a 
baneful influence, the effects of which are felt throughout the entire 
system. The well known maxim, " It is easier to rust out than wear out," 
applies with equal force to the powers of the body and mind. All the 
organs have within them an inherent force, a stimulus which excites their 
activity; health may be said to depend upon perpetual secretion and 
absorption. This organic power, while acting independently of the will, is 
yet profoundly influenced by movements of the muscles under its control. 
Voluntary muscular movements are so essential to health that without their 
employment degeneration inevitably results. A denial of sufficient exer- 
cise can be interpreted as inviting destruction of the different functions, 
loss of mental powers, and certain decay of the entire system. The impor- 
tance of the subject prompts a consideration of the effects of exercise on 
the different organs of the body. 

On the lungs. Unusual muscular effort has its greatest influence on 
the lungs. The respiration is quickened, circulation stimulated, more 
oxygen is absorbed, and carbonic acid eliminated. The amount of air 
inspired increases correspondingly with the exertion made. A man 
running at six miles an hour will take into his lungs seven times as much 
air as one lying at rest, and the expulsion of carbonic acid is proportion- 
ately increased. The exhalation of water from the lungs is also sensibly 
greater during exertion. It is accepted that carbonic acid is largely formed 

75 



PHYSICAL EXERCISE. 

in the muscles, and exorcise is necessary for its elimination. A knowledge 
of this fact - hat, when confined to the bed or a prolonged rest is 

enforced, food rich in carbon should be less freely indulged in. 

Tuberculosis, commonly called consumption, is a disease of the lungs, 
largely dependent upon defective nutrition, induced by irregularities of 
living. Deficient exercise is doubtless influential in promoting this affec- 
tion. Accustomed inflation of the lungs by muscular exertion, or after the 
manner of performers on wind instruments, promises a measure of protec- 
tion from this disease. On the other hand, immoderate exercise, persisted 
in until the breathing becomes labored and sighing, is extremely hazardous ; 
the vessels of the lungs are distended, inducing congestion, and occasionally 
hemorrhage. 

On the circulation. During exercise the heart beats quicker and with 
greater force. The arteries are dilated, and to the muscles acted upon by 
the exertion a greater supply of blood is sent. The heart, for a time, will 
safely bear a rapid increase in the frequency of its movements, but if urged 
beyond a limit it becomes embarrassed and distressed. AVhen laboring 
hard, as the contractions are feeble, the pulse grows quick and small, and 
finally unequal and irregular. The difficult breathing which characterizes 
an over-worked heart is familiarly known as " loss of wind," and is a result 
of destroyed harmony of action between the organs of resjiiration and cir- 
culation. If this disturbance be severe, and continues unrelieved, prostra- 
tion follows. An athlete familiar with this manifestation and danger, by 
careful training and judicious management during his effort, can continue 
his exertions until harmony is restored, and he recovers what is termed 
his ' ; second wind." A long-distance runner sometimes covers thirty and 
even fifty miles without stopping, suffering but little from difficult breath- 
ing, and continuing the effort until the muscular system is exhausted. 

Mounting even a few stairs is attended with a very sensible increase of 
the heart's action. The ascension of great heights is exhausting to that 
organ, and great caution should be used lest it be injured by excessive 
exertion. Tourists, seeking renewed strength by travel and relief from 
cares, are too often prompted by abnormal desires to climb to the highest 
points of every church and public building they enter, and by so doing 
they not infrequently defeat the purposes of their journeyings. 

Violent exercise, carried beyond all reasonable limitation, has been 
known in a few instances to cause a rupture of the heart. Very often it 
induces nervous irregularity, hypertrophy, and occasionally valvular disease. 

If sufficient exercise is not indulged in, the heart with other parts of 
the body shares the injury. It loses its innate strength, and as fat becomes 
deposited in its muscular walls, they lose their tonicity and suffer degen- 
eration. 

On the skin. During exercise the vessels of the skin are distended 
and the surface reddened. The glands are more active, and perspiration is 



EFFECT ON THE MUSCLES. 77 

encouraged. The perspiratory fluid, by evaporation, reduces the heat of 
the body, maintaining nearly a normal temperature. Without this action 
unusual exertion would be difficult, and prostration soon result. While 
exercise is being indulged in, there is but little danger of a chill ; the body 
should be thinly covered, or, as it becomes heated, the clothing be removed. 
It is important to remember that after exertion the body heat lessens 
rapidly, and the temperature falls below the normal. It is apparent from 
this fact that danger then exists, and that the clothing should be at once 
resumed and more added, if necessary, to prevent the least feeling of 
chilliness. 

On the muscles. During a protracted rest and long disuse, muscle 
gradually diminishes in size, and enlarges under the influence of exercise. 
It is assumed that muscular contraction stimulates the power which con- 
trols the deposit of new material, and upon activity, as its direct agency, 
the growth of the muscle is dependent. As generally accepted, the increase 
in size is due to the enlargement of the old muscular fibres and the forma- 
tion of new. 

There is a limit to the growth of muscles, and long-continued over- 
exertion invites a state of chronic exhaustion, degeneration, and wasting. 
These results are rare when all the muscles of the body have been 
uniformly exercised, because prostration usually comes on before the 
damage is done. They are most frequent when the exertion is confined to 
a comparatively small group, or single muscle. Instances are not uncom- 
mon amongst mechanics, who, for a long time devoted to some special 
occupation, are attacked with paralysis and wasting of those muscles so 
continuously engaged. 

On the nervous system. Well appointed exercise, by increasing the 
power of the muscles, diminishes nervous sensibility, and maintains the 
balance of bodily forces which is essential to health, strength, and mental 
ease. The advantages of exercise are not confined to the muscular system 
alone; the intellectual faculties are strengthened, buoyancy of spirit and 
mental activity are promoted. The student engaged in deep study and a 
course of abstract reasoning, who finds his powers of concentration lessen- 
ing, will return from a long walk with mind refreshed and elasticity restored. 

That professional athletes are proverbially stupid has led some authors 
to infer that excessive muscular exercise tends to diminish mental power. 
This deduction cannot be accepted without qualification. Persons wholly 
devoted to the cultivation of the physical, and neglectful of the mental 
powers, must needs be deficient in the latter. Again, "over-training" 
invites a general depression, shared alike by mind and body. These facts 
are established, but that exercise, even for a time excessive, still confined 
within the limits of reason, has any direct tendency to lessen mental force 
and intenseness of thought, is not to be believed. Great muscular strength 
can only exist when the general nutrition of the body is of the highest 



7S PHYSICAL EXERCISE. 

order. That this state of perfection contributes to the activity and vigor 
of the brain needs no assurance. The collegian in training for athletic 
contests must exert great force of will and practise self-denial, a fruit of 
which is determination, self-reliance, and courage. In mental training 
these qualities are essential ; by thorn the character is strengthened and 
elevated, and a moral self-control consistent with true manliness is acquired. 
Plato said that the toils and exercises of gymnastics, if over-strained, are 
likely to make men hard and brutal, but, if properly regulated, stimulate 
the spirited element of their nature, make them valiant, and discipline 
their passions. 

Exhausting physical exercise must be followed by mental rest; danger 
exists when both body and brain share alike the excessive drain of their 
forces. 

On the digestive system. Exercise induces active circulation in the 
abdominal organs, stimulating them to a more healthy performance of their 
functions. In persons suffering from stomach, liver, and intestinal derange- 
ments, well regulated exercise is an essential in treatment of such affec- 
tions. Under its employment the appetite increases, digestion is more 
rapid and complete, symptoms referable to the liver become less prominent 
or disappear, and the bowels grow more active and regular. On the 
digestive system, the combined influence of pure air and pleasing surround- 
ings is plainly evident. 

When exercise is freely indulged in, an increase in the quantity and a 
change in the character of the food is necessary. The diet should consist 
of substances easily digestible, and rich in nitrogenous elements. Exercise 
is not allowable after a hearty meal, as circulation is diverted from the 
abdominal organs and digestion retarded. 

On the generative functions. Well regulated exercise adds strength 
and vigor to the organs of this system. It lends nervous energy, lessens 
and controls promptings, and corrects abuses. Certain forms of exercise 
should be appointed for persons of abnormal desires and weakened by 
indulgences. Bicycle-riding is especially indicated in such cases. Reason- 
able bodily exertion has no pernicious influence on the growing youth. 

On the kidneys. The amount of urine thrown out of the body is 
lessened when an unusual quantity of water is eliminated by the skin. The 
amount of urea, the organic principle of the urine, expelled during 
moderate exercise is but slightly, if any, increased at the time, but is subse- 
quently greater during the period of rest. 



RESULTS OF OVER-EXERTION. 

The causes of fatigue due to muscular exertion are problematical ; a 
variety have been assigned. It is reasonable to suppose there are three 
agencies influential : (1) the entire consumption of the material necessary 



EFFECTS OF OVER-EXERTION". 79 

for continuing the contractions; (2) accumulation within the muscles of 
waste products of their own action, particularly sarcolatic acid ; and (3) 
the exhaustion of the nerve-supply, the stimulus to contraction. A period 
of rest after exertion is therefore indispensable; a new supply of contrac- 
tile material must be provided, waste products removed, the alkaline prop- 
erties of the muscle replaced, and the vital force generated. 

During muscular exertion intervals of rest are absolutely necessary. 
While exercising, activity and repose must alternate, or the effort cannot 
be prolonged. This is a recognized physical law, as instanced by the 
action of the heart, which rests between the contractions. The periods of 
relaxation during exertions of the body are generally so short, the integrity 
of the muscles is only partially recovered; still, they are indispensable, or 
exhaustion will rapidly result. As an illustration, it is less fatiguing to 
walk than to remain standing the same length of time ; and to elevate and 
lower a dumb-bell than to hold it at arm's length. It is apparent that, if 
this law of alternate activity and repose is observed, and intervals of rest 
be allowed sufficient for the restoration of the muscles engaged, they, by 
improved nutrition, will increase in size and power. If, on the other hand, 
they are continuously over-exerted, without the essential relaxation, nutri- 
tion suffers, they grow smaller, less powerful, sometimes waste, and become 
partially, if not absolutely, paralyzed. 

Exhaustion is manifested by a loss of strength and a feeling of prostra- 
tion, sometimes by acute pain, quivering movements, or spasmodic con- 
traction of one or all of the muscles which have been over-exerted. Cramp 
is a frequent and distressing symptom which attacks pedestrians, especially 
those who attempt long distances, and one which previous training is likely 
to promote rather than obviate. The evil effects upon the heart of 
excessive muscular trials have already been briefly referred to. Consider- 
ing how often and wantonly its strength is over-taxed, the wonder is that 
disease cannot more frequently be traced with positive certainty to severe 
exertion and exhaustion. Some theorists have contended that dilatation of 
the heart never results from over-exertion as the sole cause. The niceties 
of distinction are unimportant. The law controlling all muscles is that 
increased exercise of them induces hypertrophy, or enlargement. This 
process has, in the case of the heart, certain limitations, and dilatation com- 
mences when hypertrophy ends. That frequent distention of that organ 
by masses of blood, a quantity beyond its normal capacity, is instrumental 
in hastening, if not directly inducing, dilatation, is believed. 

The heart is an organ having an elasticity none other in the body 
possesses. When over-strained it seemingly recovers quickly ; it resists 
disease with a marvellous endurance, and, when finally defeated and struct- 
ural impairment has resulted, it still labors patiently to perform its 
functions. All who have watched the progress of heart affections must 
have wondered at its continued efforts after failure seemed inevitable. It 



PHYSICAL EXERCISE. 

is not surprising, therefore, that injuries due to over-exertion are for a time 
unrecognizable, and when manifested it is not always easy, and sometimes 
impossible, to trace with certainty from effect to cause. 

Rupture of the walls of the heart rarely results from over-straining, 
unless they have been previously weakened by degenerative changes. The 

inner coat of the large artery called the aorta sometimes yields and tears, 
resulting many months later in death from aneurism. The man who, after 
hearty indulgence at the table, left it hastily and ran to "catch the train,*' 
may not at the time have realized the injury he did his heart, — seldom are 
such trifling instances remembered, — and, months later, his physician 
vainly speculates on the cause of the valvular disease for which he con- 
sults him. 

Nervous derangement of the heart is a very common result of over- 
exertion. It is manifested by palpitation, pain, and rapid, irregular pulse. 
According to the estimate of Dr. Da Costa, of all the cases of "irritable 
heart" reported among the northern troops during the late war of the 
Rebellion, thirty-eight per cent were due to exhaustion, induced by long 
marches and other forms of severe exertion. Over-indulgence in any 
athletic exercise renders this functional disorder liable ; mountain-climbers 
have an especial tendency to it. 

THE AMOUNT OF EXERCISE TO BE TAKEN. 

An ancient author has said: "Whatever be in this, the passage where 
God tells Adam that in the sweat of his brow he shall eat bread, seems 
to be the injunction of a salutary penance, that is not merely a punishment, 
but also a remedy against the disorders his body would be liable to." 

While recognizing the absolute necessity of exercise to preserve the 
integrity of the body, it is very important to estimate the amount which 
an adult, man or woman, with unimpaired vigor, must indulge in to main- 
tain health in the highest state of perfection. This task is exceedingly 
difficult, and to establish a rule which can properly be applied to all condi- 
tions of health and strength is impossible. 

By some it has been stated that the work which can be clone by a man, 
daily, is one-seventh of that which a horse can do. If the work of a horse 
is considered to be equal to the one-horse power of a steam-engine, this is 
certainly an over-estimate. The hardest day's work of twelve hours noted 
by Dr. Parkes was in the case of a workman in a copper-rolling mill. He 
stated that he occasionally raised a weight of ninety pounds to a height of 
eighteen inches, twelve thousand times a day. This would be equal to 
raising in the same time seven hundred and twenty-three tons one foot 
high. It has been estimated that four hundred tons lifted one foot is a 
hard day's work, and three hundred tons lifted to the same height is an 
average day's work for a strong, healthy man. Dr. Houghton has shown 



TIME FOK EXERCISE AND LABOR. 81 

that walking on a level surface at the rate of three miles an hour is equiva- 
lent to raising one-twenty-ninth part of the weight of the body through the 
distance walked. According to this calculation, a man walking twenty 
miles a day without load, his effort would be equal to lifting three hundred 
and fifty-three tons one foot, and would be considered good work. If 
ascending heights, he would raise, in addition, his own weight through the 
height ascended. 

It seems fair to assume that every healthy man ought, if possible, to 
take each day a walk of nine or ten miles, or exercise equivalent to it, 
With this as a basis, it will be easy for each to estimate with sufficient 
accuracy the amount necessary to keep himself in good condition. 

To consider the merits of different forms of athletic exercise is beyond 
the province of this work. The general rule, that all muscles should be 
uniformly developed, must not be forgotten. Probably walking at a brisk 
pace is justly entitled to take precedence. By moving the upper part 
of the body and arms with each step, nearly all the important muscles are 
brought into action. In addition to this are to be considered mental im- 
pressions, the diverson, the enjoyment of pleasant surroundings, and the 
invigorating influence of pure air. 

THE TIME FOR EXERCISE AND LABOR. 

During digestion, while the food is being acted upon by the gastric juice, 
the nervous energies of the system are attracted to the stomach and con- 
tribute to the performance of its functions. That their aid is needed is an 
established physical law, obedience to which is one of the essentials to 
health. If, for a time after eating, bodily or mental exertion is made, the 
nervous energies are distracted from their assigned duties, and digestion 
suffers disturbance, and possibly interruption, from the withdrawal of the 
needed assistance. 

The truth of this theory is apparent. After hearty indulgence at the 
table, especially at dinner, all are disinclined to much bodily action or 
mental effort ; the nervous energies are not easily recalled from the proper 
performance of their duties, and are reluctant to disobey the natural law 
under which they are acting. To attempt hard work or close study within 
an hour after eating invites derangements of the digestive organs, and the 
habit, if persisted in, induces a long train of symptoms indicative of 
impaired nutrition, debility, and disease. In the old maxim, "After 
dinner sit a while," is advice the worth of which is beyond estimate. 
Domestic animals are allowed their periods of rest after eating; no one 
would think of urging a valuable horse at once after a generous feeding. 
Many men, consistent in this instance, will yet persist in a denial of self 
the rights and indulgences they readily concede to their animals. The 
farmer, in his busiest season, who allows his assistants to linger at the table 



82 PHYSICAL EXERCISE. 

or spend an hour in leisure preparation for the afternoon's labors, will find 
more accomplished when night comes than would have been done had he 
hurried them into the fields. 

Those devoted to the labor of study will find as good results from the 
observance of this rule, so essential to an equable balance between the 
physical and mental systems. Immediately after eating the mind is 
unfitted for great activity, close reasoning, and concentration. It is 
economy, as well as health, to yield obedience to this natural law, which 
few recognize ami too many violate. Submission is rewarded by comfort 
and vigor; transgression is punished by derangements and, after a time,, 
disease. 

Literary men should exercise when the stomach is empty, or during 
intervals preceding meals. After exertion and before indulging in food, a 
brief rest soon restores the nerves, and they are prepared for the task 
before them. 

Persons of active or laborious habits can make their business subserve 
the purpose of exercise. They should properly estimate the value of a 
change when opportunity permits, and court the healthful influences of 
relaxation, mental enjoyment, and pure air. 



CHAPTER IV. 

SLEEP. 

As rest and exercise are essential to bodily health, the alternate changes, 
repose and activity, are equally indispensable to the support of mental 
vigor. Sleep is an absolute requisite to mind and body, as food is neces- 
sary to the general system. 

The value of sleep is sufficiently apparent from the effects which it 
produces. It restores the powers both of mind and body when exhausted, 
by renewing intellectual force and physical strength. Under its influence, 
tired muscles, rendered rigid, painful, and trembling by hard labor, again 
become active and movable. The heart, which during waking hours has 
been urged to greater efforts, finds during sleep a measure of rest ; it beats 
less quickly, and seems to gather strength for the coming day. 

Intense mental application is, in proportion, more fatiguing than bodily 
exertion ; only sleep can completely restore the functional activity of the 
brain. It has been said that those who possess and employ the powers of 
the mind the most, seldom attain the greatest age. Those who have lived 
longest have been persons without either avarice or ambition, strangers, in 
fact, to great mental labor. 

While sleep is essential to life and health, and deficiency of it enfeebles 
the entire system, over-indulgence is followed by nearly like effects. The 
proportion needed to maintain the integrity of mind and body must be 
determined by individual needs. In a general way, it may be said that the 
body should be exercised and the mind employed until fatigue is experi- 
enced, and no longer; sleep should be indulged in until one is refreshed, 
and no longer. He who becomes uneasy in bed should leave it ; when 
Nature calls again for rest, her dictates should be followed, regardless of 
the time or hour. This rule may be observed in health ; in sickness control 
is, in a measure, lost. 

Many literary men and close students, familiar with physical laws and 
obligations, are fully alive to the fact that "a forty winks' nap" in a hori- 
zontal posture is the best preparation for an extraordinary mental effort. 
For them, when fatigued, to leave their labors for a few moments' sleep, 

83 



84 BLEEP. 

oven during the day, is not unusual; they are well repaid by fresher 
thought and renewed activity. 

- impossible to regulate sleep by the hour; when its full and re-ani- 
mating influence is expended, people do not care to remain in bed; until 

then they should not rise. The repose requisite to supply the deficiency 
occasioned by the action of the day depends upon the habits and health of 
the individual : it should not be less than seven, and need not be more than 
nine, hours. If sleep is profound and unbroken, less of it is required. The 
quantity must depend upon the facility with which the power of the ner- 
vous system is restored. The sleep of infancy is the most profound; the 
young and growing need more than the matured. The most refreshing 
repose is that which is entered quietly and seems to have passed quickly. 

By discipline a certain control over the mind is acquired, and sleep can 

summoned at will. It is proof of a disordered brain if this cannot be 
accomplished. When a man, worn by the duties of the day, finds sleep 
impossible, it is an evidence that the intellectual faculties have been, for 
the time, weakened by over-exertion. If he becomes habitually indisposed 
to sleep at a seasonable hour, he may conclude that he is suffering from 
Sume habit of excess ; a change in his mode of living should be made, his 
thoughts diverted, and bodily exercise resorted to. 

It has been stated that the refreshing influence of sleep is not in the 
simple ratio of its duration, the principal part of this act of restoration 
being found to take place in the beginning of it. If a person be at any 
time deprived of one-half or more of his usual portion of it, the incon- 
venience experienced is by no means in proportion to this privation. 
Habit is powerfully influential in limiting the number of hours which should 
be passed in bed, with health and vigor maintained. Custom can, in a 
measure, shorten or extend the allowance. 

The truth of the saying, " One hour's rest before midnight is worth two 
after," is sustained. Old people who have passed beyond the usual limit of 
life have uniformly agreed upon one point at least, that they all retired 
early and arose early. Whether early rising promotes long life is problem- 
atical ; certainly late hours shorten it. 

Nature evidently intended the gloom and the stillness of night for 
repose, and the day as best adapted for active employment. Those who 
are forced to habituate themselves to a small allowance of sleep should 
practise regularity in the hour of retiring, doing so as early as possible. 
They will suffer less from the deprivation of the morning hours of rest. 

Those people who live in the country proverbially enjoy better health 
than those who reside in cities. The reason of this is not alone that the 
air is pure; quiet, methodical customs, and sufficient undisturbed sleep are 
equally, if not more powerfully, influential. By rising early, more exer- 
is indulged in by them, and better appetite promoted; food is taken 
at regular intervals, and the entire tenor of their lives conduces to strength, 



ADVANTAGES OF EARLY IMS TNG. 85 

activity, and greater age. Residents in cities are in general more irregular 
in their habits; they are given to excesses, have cares and anxieties, real 
and imaginary; they arc not so well nourished, and restoration of systemic 
wear and waste is less perfectly performed. Dyspeptic and nervous dis- 
orders which tend to shorten life are too often the consequences of the 
so-called pleasure of fashionable life. Sleep in cities is often disturbed by 
noises, while the stillness of night in the country is unbroken and profound. 



THE ADVANTAGES OF EARLY RISING. 

The following instructive article is quoted from the Boston Medical 
and Surgical Journal, May 15, 1884: — 

"The subject of early rising has a physiological and a therapeutical 
aspect. It may be laid down as a general proposition, applicable to the great 
majority of men, women, and children in health, that the proverb, 'Early 
to bed, early to rise,' etc., embodies sound common-sense, and is safe to 
follow, enabling those who conform to it to perform the greatest amount of 
work of which they are capable, with economy of time, of eyesight, of 
nervous energy, and of the general health. The tendency of modern civili- 
zation has been to lead people to greatly disregard nature's law (to which 
the inferior animals generally conform), whereby night is the time for rest, 
and day is the time for toil. This law is a result of natural selection, as 
pointed out by one of its great apostles. 'An animal so constituted that 
waste and repair were balanced from moment to -moment, throughout the 
twenty-four hours, would, other things equal, be overcome by an enemy or 
competitor that could evolve greater energy during the hours when light 
facilitates action, at the expense of being less energetic during the hours of 
darkness and concealment.' 

"Early rising is the proper sequel of early retiring, and when recom- 
mended as a hygienic rule it is with the presupposition that ample time — 
which with every individual is a fixed quantity — shall have been devoted 
to sleep. The majority of laboring people, in accordance with the neces- 
sity in most adults for about eight hours sleep a day, have w r isely chosen the 
period between nine o'clock in the evening and early morning, and farmers, 
who, retiring in the summer at dark, arise at daybreak, testify to the 
extraordinary salubrity of the morning air. The atmosphere then is cooler 
and more invigorating, more heavily charged with oxygen, than later in 
the day, when rarefied by the heat of the sun. There is no time so favor- 
able for exercise, as students well know who are in the habit of taking 
long walks or practising gymnastics in the morning before breakfast. An 
hour spent in exercise at this time of day w T ill fortify a student more than 
two hours of bodily training at midday, and this season should be chosen 
for physical rather than for mental exercises. If sufficiency of sleep be 
necessary, excess of time spent in repose is enervating and harmful ; it 



SLEEP. 

promotes languor of the circulation, and thus induces torpor and conges- 
tion of the viscera; it interferes with the energetic performance of the 
respiratory function, on which the due oxygenation of all the tissues 
depends; muscular tonicity and nerve-nutrition are also enfeebled by pro- 
longing the season of sleep. 

" From what has been above said it may be inferred that in pathological 
states where, in common parlance, the biliary function is said to be 
deranged, early rising, with exercise in the open air, will be of j)owerful 
therapeutic efficacy. The blood is charged with the products of defective 
oxidation, the result of over-eating or over-work (or both combined), and 
all the symptoms of liver indigestion ensue. Here the best hygienic advice 
is that of old Dr. Abernethy, 'An axe, a cord of wood, and five o'clock in 
the morning!' Under this regimen the 'biliousness,' with its attendant 
headaches, malaise, loss of appetite, etc., will often disaj)pear as if by 
magic. If it is 'the early bird' that catches 'the worm,' it is the early bird 
that can digest the worm. Dr. Abernethy's advice applies to many cases 
of simple dyspepsia, which will be more speedily and permanently bene- 
fited by early rising than by wine bitters and pepsine ; it may also be 
indicated in gout and diabetes, which are diseases of mal-nutrition. 

•■As for nervous disorders, those characterized by spasm are, as a rule, 
more amenable to this kind of hygiene than paretic diseases, a recumbent 
posture increasing spinal reflex activity. Epilej^sy and hysteria have both 
been benefited by the establishment of correct habits of sleep and by early 
rising, and to a certain class of debilitated young men (with whom every 
physician has much experience) no counsel is more important than to rise 
as soon as the first sound sleep is over. As for cases characterized by 
exhaustion and loss of power, long-continued rest is often the only treat- 
ment that does any good. The damaged nervous elements have lost the 
power of rapid recuperation under sleep, and early rising would, in such 
patients, be a cruelty, if not an impossibility. Eeserve force is lacking, and 
morning weariness is often overpowering. Other persons are neurasthenic 
from want of a proper hygienic education, and cannot be too much 
exhorted to curtail the hours devoted to enervating inaction. To such 
patients the effort, persisted in, of 'early springing from the bed of sloth,' 
and engaging in some energetic occupation, is a victory over their 
infirmity. 

"In anaemia and chlorosis a 'morning air-bath' (as Dr. Franklin styles 
it) is often more beneficial than a course of iron and arsenic. The victim 
of insomnia must sometimes, perforce, lie abed in the morning; hours lost 
in vain attempts to go to sleep may be partially made up by prolonging 
the season of rest, and subsomnolent states are, as Dr. Crichton Browne 
observes, the next best thing to sleep. For the great majority, however, 
of people who are not bed-ridden, a matinal walk is better than medicine." 



AMOUNT OF SLEEP REQUIRED. 87 

THE AMOUNT OF SLEEP REQUIRED. 

Sleep is more especially required to restore the powers of those muscles 
which act independently of the will, such as the heart, which never sleeps. 
The consumption of materials which furnish force to the involuntary 
processes of life must, of course, continue during repose ; but still, there 
is no doubt that strength and energy are recruited while the body slumbers. 
The brain, from which all vital power emanates, recovers its force and 
activity; in turn, all functions under its control are given new life and 
energy. 

If the mind has been greatly disturbed by fear, anxiety, or violent 
excitement, sleep is the more necessary. These conditions of mind exhaust 
the system more than the most fatiguing bodily labor. For this reason, 
when sleep comes to those prostrated by grief or sorrow, it is deep and 
prolonged. 

Since mental labors are more fatiguing than those of the body, it is 
evident that literary men and others given to deep thought require a 
greater allowance of sleep. It has been said those who enjoy the most 
perfect digestion require less bodily rest than others, in whom this act 
is performed more slowly and with difficulty. Nature seems to invite 
this enjoyment after a hearty meal ; she appears desirous of concentrating 
her forces on the task before her. 

In winter and summer there is greater demand upon the vital energies; 
by extremes of cold and heat circulation is retarded or accelerated. In 
these seasons more sleep is demanded than in spring and autumn, when the 
blood flows in its channels uninfluenced by external impressions. 

In correctly estimating the amount of sleep essential for individual 
needs, the natural wants of the body must not be confounded with a faulty 
custom. Very many people sleep too much, or linger in bed longer than 
they ought. Such a habit is pernicious; the inactivity lessens the muscu- 
lar powers, and tends to enfeeble the entire system. It promotes indolence 
and inaptitude for mental or bodily labors. Elderly people and invalids may 
quite properly be allowed their "noon-day nap" ; it need not usually exceed 
an hour in duration. Unless there is some positive indication for indul- 
gence in this custom, such as age or disease, the habit should not be 
acquired. 

The manner of rising in the morning will, in a measure, indicate 
whether or not sufficient sleep has been indulged in. If people in good 
health awake quickly, are cheerful, and feel the bodily strength has been 
renewed, then Nature has been satisfied. If, on the other hand, they are 
depressed, spiritless, and disinclined to activity, the amount of rest has been 
inadequate to the need. This rule is rendered inoperative by disease, or 
mental and bodily derangements ; all persons who awake feeling dull and 
fatigued should at once determine the cause, if possible. 



88 SLEEP. 

Sloop maybe prevented, both in healthy people and invalids, by various 
influences. The surroundings may not favor repose, and wakefulness often 
results from mental emotions, snob as anger, fear, anxiety, expectancy, and 
joy, imagination and remembrance of the past, — in fact, any unusual appli- 
cation of the mind. 



THE SLEEPING-ROOM AND FURNISHINGS. 

It is a fault plainly apparent in modern architecture, that the impor- 
tance of sleeping-rooms, in nearly all houses, is not properly estimated; 
they are small, and have very low ceilings. The hand of fashion and the 
promptings of vanity are painfully evident ; a room merely large enough 
to admit a bed is too often thought quite sufficient as a sleeping-apartment, 
in use so many hours daily, while the more desirable rooms, rarely entered, 
are set apart solely for display. The bed-rooms should be large and airy, 
pleasantly situated, and aceessible to sunlight. They should be furnished 
with those articles only which are indispensable; pictures and other orna- 
ments permit the accumulation of dust, and therefore may properly be 
dispensed with. In none of the domestic arrangements is good taste so 
easily recognized as in the sleeping-apartments ; gaudy furnishings may well 
be displaced by rigid simplicity. In many houses one or more sleeping- 
rooms adjoin and are connected with the bath-rooms. Even if every sani- 
tary precaution is taken, and the most approved system of drainage is 
introduced, there is still danger from sewer-gas. If there are connecting 
doors they should be sealed up, and in constructing new houses the parti- 
tions between the sleeping-apartments and bath-rooms should be thick and 
impenetrable. Not only should this precaution be observed, but also should 
the latter rooms be invariably well ventilated ; and, if pure air can in 
no other way be obtained, the windows ought to be left opened, slightly at 
least, while the room is unoccupied. Among the many diseases induced 
by sewer-gas is catarrh of the throat and nasal passages. After this dis- 
order is acquired, deafness, due to inflammation of the middle ear, not 
infrequently follows. With such a dire result possible, no expense or 
inconvenience can be considered great, if protection is secured. 

A bedstead movable and easily disjointed is most suitable ; if made of 
iron or brass, rather than w r ood, it is preferred by many. Curtains, now 
rarely in use, are objectionable, as by them free circulation of air in the 
room is interfered with. 

An elastic hair mattress is incomparably the most grateful to the tired 
body. By reason of cost, all cannot procure them, and some substitute 
must be accepted. In selecting from the cheaper varieties, the firm and 
somewhat compact are the most suitable, as they support the body more 
evenly. Feather beds should be discarded; they readily absorb impurities, 
and are not easily cleansed. They unduly heat the body, and interfere 



THE SLEEPING- ROOM. 89 

with ventilation. One accustomed to their use is reluctant to dispense 
with them, but, if persuaded to do so, lie soon finds a harder mattress an 
agreeable substitute. 

Bed-springs are now very popular; they are a source of comfort, and, 
if properly constructed, may wisely be employed. The weight of the body 
should be evenly distributed, without undue strain upon any one part or 
spring; those made of woven wire are said to exeel in utility and dura- 
bility. 

Pillows filled with hair are preferable to others; feathers are a frequent 
cause of asthmatic attacks in people predisposed to the disease. In size, 
the pillows should be sufficiently large to sustain the head slightly above 
the level of the body; when raised too high, circulation through the neck 
is interfered with, and unpleasant dreams are one of the consequences. 

For people of strength and unimpaired vigor, the best material for 
sheets and pillow-cases is linen. For those in whom circulation is defec- 
tive, cotton will be the most comfortable; by reason of its cheapness and 
durability, it is now commonly used. 

The bed-coverings should be light and warm; blankets of all wool, 
combining both qualities, are the best. Rather than one very thick, sev- 
eral light coverlids are much the warmest; the old-fashioned "comfort- 
able " of quilted cotton, for this reason and because of its weight, should 
never be used. To sleep in a bed overloaded with clothes is highly im- 
proper; they heat the blood and induce immoderate perspiration, by which 
chills are invited, or the system is weakened. 

It is important to health that all the clothing about beds should be 
carefully aired for at least an hour every morning. Offensive emanations 
from the body are absorbed by the clothes, and exposure to the air is in- 
dispensable in their removal. The strong rays of the sun are a powerful 
enemy to unhealthy germs, which often find lodgement in sleeping-apart- 
ments, especially those infected with disease. 

That the room may be properly ventilated during the night, the sleeper 
should be comfortably clothed. Many people are in the habit of leaving 
their windows widely open during the winter, thinking doubtless that the 
colder the air, the purer it must be; in this custom there is danger. Proper 
ventilation can be enjoyed without a chill air; it should be an object 
to secure as nearly as possible an equable temperature for both day and 
night. If one is exposed to intense cold during the former, he should not 
choose a warm room to sleep in ; extremes must be avoided. Women 
who in winter have been warmly housed during the day should not 
attempt to pass the night in a room with open windows. If it has been 
carefully aired, and is not artificially heated, if the apartment is large and 
is occupied by one person only, doubtless sufficient pure air for proper ven- 
tilation will enter around the windows and casings during inclement 
weather. 



SLEEP. 

y who wear woollen underclothes during the day are absurdly ac- 
customed to remove them on retiring, and to sleep in their night-dresses 
of linen or cotton. The under vest for night wear should be as heavy and 
warm as that employed during the day. The one removed on rising 
should be carefully aired with the bed-clothing: during the night the 
other should be hung over a chair near a window. 

Night-dresses i I cotton are preferable. In summer a thin mate- 

rial may be chosen, for winter use the so-called " cotton-flannel" is the 
most comfortable. The night-dress should be long, loosely fitting, and 
button easily about the neck. Those people who are habituated to sleep- 
ing with the arms uncovered, ought in cold weather to be secured against 
chills by thick under-flannels. 

To dress or undress in an intensely cold room is a hardship which 
should if possible be escaped. Wood stoves, so rapidly heating, are far 
better for chambers than those in which coal is burned ; light kindlings 
E d warm them sufficiently, and the temperature quickly falls after the 
sleeper has enjoyed his sponge-bath, and is comfortably ensconced in bed. 

The rigid law of health declares that no more than one person should 

sleep in the same bed. and when practicable, separate apartments, as well 

- separate beds, should be assigned to each. This rule applies alike to 

children and to adults, and no good reason, excepting perhaps the plea of 

economv, can be advanced to invalidate the wisdom of it. 



CHAPTER V. 
BATHING. 

On the free and healthy action of the skin depend much the sanity 
and vigor of the organical changes going on within the body. The effects 
of bathing are felt not on the surface merely, but to the entire system its 
influence is extended. The functions of the internal organs and the intel- 
lectual faculties are stimulated or depressed as the bath is wisely or inju- 
diciously applied. 

It must be appreciated that the skin is more than a simple covering; 
it is an organ exceedingly delicate in structure, and among the first in im- 
portance in the animal economy. It is designed to protect the parts 
beneath from mechanical injury, and is interposed as a shield against 
excessive heat and cold. It abounds in blood-vessels, which, by their 
dilatation and contraction, largely regulate the temperature of the body by 
controlling perspiration. The capacity of these vessels, and the impor- 
tance of cutaneous circulation, cannot be over-estimated. As a hot bath 
fills and distends them, drawing the blood from the brain, so a chilling of 
the surface contracts, forcing their contents to the internal organs, and in 
them inducing congestion. 

The perspiratory glands are scattered everywhere throughout the skin, 
and their function is an important one. The office of the perspiration is 
chiefly to maintain the body at a uniform temperature. About two pounds 
of it are, under ordinary circumstances, secreted in twenty-four hours. 
In this quantity, perspiration is not appreciable ; it has been termed " in- 
sensible," and the fluid does not reach the surface, but remains within the 
layers of the skin. If the body is exposed to a high temperature, or under 
the influence of violent exercise and rapid circulation, the cutaneous glands 
are excited to unusual activity, and their contents pour over the exterior. 
The perspiration then becomes " sensible " ; the fluid evaporates, and, by 
gaseous generation, the surface is cooled down to the normal degree. 

The sebaceous are nearly as numerous as the perspiratory glands; 
their secretion lubricates the skin, and aids in the exclusion of foreign 
fluids and gases. 

91 



QO 



BATHING. 



The process of respiration is not wholly confined to the lungs. Exper- 
iments have proved that oxygen is absorbed and carbonic acid given off 
from the skin; the amount of the latter being about one-thirtieth of that 
discharged from the lungs. 

By an intricate and complete system of nerve-distribution, every im- 
pression made on the surface of the body is communicated with a sensible 
effect to the great centres. Mental impressions are often manifested by a 
changed condition of the skin, as illustrated by the pallor of fear, the 
blushing of shame, and the beaded drops of perspiration in great anxiety. 

A thorough understanding of the functions of the skin suggests how 
essential to health is its unimpaired vitality. Through it as an outlet 
many impurities are thrown from the system; their retention would be 
productive of disease. The exhalations are emitted by means of little ori- 
fices or pores. These are easily obstructed by the discharged matters, 
by deposited dirt and dust, and the surface of the body becomes covered 
with thin scales which are constantly exfoliated. Not only is the frequent 
removal of these accumulations necessary, but the process by which they 
are displaced stimulates and promotes healthier action of the skin, by its 
influence upon the cutaneous nerves and circulation. 

The toilet-bath. It is obvious that the most exposed parts of the body 
should be bathed twice a day ; often er, if unusual dust and accumulations 
are encountered and deposited. Some have advocated the use of tepid 
water, but this custom has its disadvantages, and cold water is advised, 
especially in the winter months. Catarrh of the nasal passages, it is 
believed, is invited by the use of warm water for the toilet in chilling 
weather : those habituated to its employment are less impervious to cold 
and sudden climatic changes. Few that have suffered from what is com- 
monly termed "a cold in the head," but know from experience the relief 
which follows the profuse application of cold water to the head and neck. 
At the toilet it is well to remove the undervest, and wash carefully the face, 
neck, arms, and upper part of the chest. Ladies are denied the luxury of 
bathing the entire head ; men are more fortunate, and water can be used 
freely in every part. It is to be remembered that, in cold weather espec- 
ially, the hair should be thoroughly dried by a brisk use of towels. Before 
retiring, if general bathing is not indulged in, neatness demands that the 
feet, groins, and neighboring parts be well washed. 

The sweat-glands in these parts produce in some persons a modified 
kind of perspiration, different from the normal. It is then offensive in 
odor, and a source of great discomfort to themselves as well as to others. 
If the clothes are not often changed and bathing frequently indulged in, 
this odor becomes intolerable. Occasionally the disorder of the sweat- 
glands, in the groins and arm-pits especially, is accompanied by a tender- 
ness and irritation of the skin, induced by a softening action of the 
unhealthy secretion. 



THE TOILET-BAT I L. 93 

The treatment to be employed in such cases is to wash the affected 
parts twice a day, using carbolic or tar soaps. After cleanliness is pro- 
moted by this process, if the disorder does not disappear, an ointment, 
made of salicylic acid, one-half drachm, and vaseline, one ounce, may be 
applied morning and night after washing. This ointment has both a dis- 
infectant and a healing property. 

Excessive sweating may be a local or a general manifestation. To 
some it is confined to the hands, they being affected to such an extent 
that to wear gloves is impossible ; the hands are always moist, and 
have a cold, clammy feeling. In these persons the feet are usually simi- 
larly affected; the boots and stockings become saturated, the retained 
sweat decomposes, and gives off a fetid smell. Sometimes the soles of 
the feet and toes will soften, and become very tender from the effects of 
this secretion. 

The treatment for the excessive sweating of the hands is the salicylic 
ointment above mentioned ; or dry rjowdered zinc, or the oleate of zinc, 
well rubbed into the palms after washing, will be preferred by some. A 
very good application to the arm-pits, besides that already suggested, is 
boracic acid ointment, made by adding one-half drachm of the powder to 
one ounce of vaseline. Starch powder can also be used to advantage under 
the arms, and, if needed, a pad of absorbent cotton may be continuously 
worn. The proper treatment for excessive sweating of the feet is advised 
in the section devoted to the care of that part of the body. 

Occasionally sweating will induce discoloration at the arm-pits and 
groins. The most common color is red; the perspiratory fluid is not in 
itself so much colored, but the change is produced by the red bacteria 
which it contains. Generally, no treatment for this appearance is needed, 
unless it is persistent, in which case the boracic acid ointment will be found 
efficacious. 

While many are troubled with excessive perspiration, occasionally will 
be found persons in whom the skin is dry and parched. This condition is 
induced by deficient action of the perspiratory glands, they being, as it 
were, robbed of their secretion by increased activity of the kidneys. It 
will be found that many who complain of a diminution of sweating have 
some urinary disorder. It is apparent from this that a strong sympathy 
exists between the sweat-glands and the kidneys ; when one is deficient, 
the other does its work. Internal treatment for this complaint is iinpera- 
ative, and a physician should be consulted. 

No more soap should be used in toilet-bathing than is necessary to easily 
remove the accumulations; the amount must be measured by individual 
needs. A lady with a dry, delicate skin, sheltered from dust, will require 
less than a man whose employment exposes him to such accumulations. 
Some persons have shining, glistening faces; in them the oil-glands are 
unusually active, and on the skin deposit their contents in excess. In such 



94 BATHING. 

see i re a >ap will be needed to remove the secretions. The fingers or 

sponges are advocated in washing; about the face coarse cloths are liable 
to irritate delicate skins. 

In the selection of toilet soaps economy is too often considered, and it 
is to be deplored. In the cheaper qualities rancid fats and questionable 

ingredients rind place, disguised by pleasing odors. Purchasers must 
not expect the genuine for the price of the counterfeit. Dealers of 
repute should be sought, rather than the bazars of wondrous cheapness 
patronized. The pure white Castile soap takes precedence, but that imita- 
tions are common is to be remembered. Transparent soaps admit of less 
corruption than the opaque, and for this reason can generally be depended 
upon as unadulterated. Those stronger in alkalies are needed for the un- 
commonly greasy and dust-covered skins of mechanics. They should be 
used quickly, and at once thoroughly removed by clean water. 

The pernicious result following the improper or excessive use of too 
strong soaps is frequently seen in washerwomen : the skin of their hands 
and arms becomes dry, harsh, and easily broken. The condition is induced 
by the action of the soaps, which wash out all the secretion of the oil- 
glands, depriving the skin of the material on which much of its softness 
and elasticity depends. 

General bathing. Baths for the entire body respond not alone to the 
demands for cleanliness, but alike promote health, comfort, moral purity, 
and intellectual vigor. Very many in the lower walks of life give little 
heed to Xature's needs; bathing is but seldom indulged in by them. They 
seemingly hare good health, and retain constitutions apparently un- 
impaired by this neglect. Among such, however, epidemics find the 
soil well tilled, and seeds of contagion propagate and richly thrive 
where filth abounds. TTith these people fatality is proportionately 
greater: they have not only less resistant capability, but are also wanting 
in re-active powers. 

While frequent bathing is a necessity, its value may be enhanced by a 
clear and accurate knowledge of the properties and the effects produced by 
the different baths, and also their correct application to the constitutions of 
persons who make use of them. The condition of the system regulates 
the effect of the bath. Heat and cold, in themselves, are neither strength- 
ening nor debilitating, but become so merely in consequence of certain 
states of the body at the time of their employment. The same application 
which, in the person of great physical power, yields increase of strength, 
may tend to debilitate the feeble. That agency which is a stimulant, when 
used in moderation, becomes rapidly destructive when due limits are trans- 
gressed. Xature, by her life-contributing force, sustains a uniform bodily 
temperature. It has been estimated that this process is carried on Avith 
the least expenditure when the atmospheric air indicates 60°. Sudden 
and material deviations from this point, whether by a rise or fall of tern- 



THE COLD BATH. 95 

perature, if long continued, make equal demands upon the vital power, and 
produce relaxation in keeping with the extent and duration of the cause. 
If the temperature of the blood be affected by cold intense and protracted, 
a fatal result follows. 

Agencies which promote activity are stimulants, and all influences 
which quicken the heart and excite the nerves, to be harmless, must be 
proportioned to the degree of vigor existing in the person who receives 
the impressions. 

Heat and cold both operate in the same manner by exciting the vital 
energy. The use of either in excess surely debilitates, disorders, and 
endangers the system. The constitution, state of health, and individual 
peculiarities, must be influential in determining the form of bath which 
should be employed to attain the best results. 

The cold bath. The application of cold, when made to wisely chosen 
subjects, is an admirable tonic. The fact that, like other remedial agen- 
cies, it is not adapted to every case, should not be forgotten. No fixed 
rule can be established for all; peculiarities of disposition, temperaments, 
and individual susceptibilities, must be carefully considered. In a general 
way, it may be said that cold bathing is preferable when a vigorous habit 
exists; it is injurious when the general strength is too feeble to admit of 
re-action under its influence. In debility, unaccompanied by any organic 
diseasa, which arises from excesses, such as dissipation, sedentary occupa- 
tion, deep study, and literary application, cold is an agency which proves 
bracing and salutary. It is also to be employed when the system is 
relaxed by indolent habits, sleeplessness, and mental unrest. During con- 
valescence from fevers and tedious illnesses, its cautious use is productive 
of good results. In constipation it will often prove beneficial. For 
chronic catarrhal affections its application is an essential in treatment. 
Persons who "take cold " easily will find the daily bath of cold water a 
most effectual means of prevention. The corpulent need its tonic influ- 
ence ; the same may properly be said of the dyspeptic, and those of the 
so-called bilious temperament. When a great mental effort is to be made, 
deep thought and close reasoning indulged in, a cold bath will stimulate 
the faculties, quicken perceptions, and edge understanding. The victim of 
nervous disquietude who finds chloral at night, and the bromides by day, 
necessities, should know that a cure must be sought amongst agencies 
which strengthen the nerves; those which merely render them dull and 
inactive will, after prolonged use, bring inevitable destruction of vital 
force. For the unfortunates designated as " nervous," cold bathing prom- 
ises the best results. The same advice is given to the many in whom cir- 
culation is defective, and coldness of the extremities is a constant cause of 
complaint. A daily immersion of the feet, followed by a brisk rubbing, 
will insure continued warmth for those members, and in them prevent 
unusual perspiration. 



BATHING. 

The cold bath is unsafe in old age, in great debility, pregnancy, when 
serious organic disease exists, and in many of the acute affections. In 
kidney disorders, it is especially forbidden. 

Probably there are some, without disease, who will hesitate to apply 
cold, apprehensive of injury, and uncertain whether or not its use by them 
is judicious. The fact can be easily determined. If, after the general 
shock to the system, a sense of unusual heat in the skin is experienced, 
accompanied, by a perceptible increase of strength and a pleasurable, 
invigorated feeling, then it is evidence that the nerves, blood-vessels, and 
all the organs of the body are excited to a more healthy and energetic 
performance of their functions. When this re-action does not occur, the 
failure is sufficient proof that some weakness or bodily peculiarity exists, 
which precludes the further use of the cold bath. 

Many who can properly and wisely indulge in cold bathing, at first do 
so unwillingly, feeling the practice too great a hardship. This reluctance 
can be overcome, and a passion for it acquired. To learn to anticipate it 
as a luxury, it will be well to commence with tepid bathing, lowering the 
temperature each day until warm water need no longer be added. This 
rule should always be observed by convalescents, and where the debility is 
very great or of long continuance. 

Under all conditions, a cold bath applied to the whole body ought to be 
of short duration ; its value is in the first impression which is made on the 
skin and the nerves. The immersion should always be sudden ; the effect 
is then uniform. If the water is entered hesitatingly, the blood is driven 
from the lower extremities to the upper parts. The shower bath is espe- 
cially advocated for its sudden and general shock, and its application to the 
head, which should share the general immersion. Very many lack the con- 
veniences of bathing, and yet none can be denied sponge-baths. These 
are easilv applied, and are a general luxury, the deprivation of which is 
deeply felt when once the habit of indulging in them has been confirmed. 

The ancient theory that after violent exercise, and while perspiring 
freelv, the body should be allowed to cool before immersion, is no longer 
accepted. It is the custom of the most intelligent athletes, after unusual 
effort and while intensely heated, to disrobe quickly and be immediately 
drenched with cold water; the same being poured from over the head. It 
would certainly be judicious to exercise before bathing; thereby circulation 
is stimulated, the temperature of the body elevated, and re-action after the 
application of cold is insured. 

Many writers have in the past dwelt long and emphatically upon the 
dangers of too frequent cold bathing ; their arguments are mere repeti- 
tions, and antiquity lends them their greatest force. As an essential to 
cleanliness, it should be employed two or three times each week, and as a 
luxury it may safely be enjoyed daily. Dr. John C.Warren said: "In 
hot weather, I personally employ the shower bath with great freedom: I 



THE WAIIM BATH. ( J7 

resort to it three or four times a day, and find it to produce great refresh- 
ment from the debilitating effects of heat." 

Water with a temperature of 50° may be considered as sufficiently cold 
for bathing; it may be used at any degree below that point, but it cannot 
be borne long. 

The warm bath. If water of about the temperature of the body is 
used, it may properly be termed a warm bath; when employed between 
four and twelve degrees above that point, from 103° to 110°, it is consid- 
ered a hot bath. 

By warm baths the blood-vessels of the skin are dilated, and the tem- 
perature of the body is raised. The sensation of heat excited is agreeable 
and refreshing; the strain of the system seems relaxing, and unusual 
excitement lessens as under a sedative. The tranquillizing influence on the 
nerves seems to favor renewed activity of disturbed functions ; increased 
vigor appears established. Bathing in warm water is deliciously refreshing 
after exhausting fatigue, prolonged sleeplessness from disease or exertion, 
intense mental disturbance, and other influences so powerful as to induce 
sudden and great debility. It is one of the most useful of remedial 
measures. As has wisely been said, "the remedy may be made a luxury, 
the means of health a cause of disease." For cleanliness and to favor the 
use of soaps, it may properly be occasionally indulged in by all. 

The vigorous and well nourished should employ warm baths only when 
some unusual condition of the system demands their application. Persons 
so constituted, by too frequent indulgences, become indolent, inactive, and 
predisposed to excessive formation of fat. 

There are but few conditions of life, when cold cannot properly be 
applied, that warm-water baths may not be judiciously administered. 
Patients of delicate habit, during certain febrile affections, in exhaustion 
from long illnesses, and even when suffering from organic diseases, will find 
advantage from their use under proper restrictions. In old age they are 
particularly indicated, as calculated to lessen or remove the stiffness and 
debility which attend it. Ladies, during the period of pregnancy, and 
when suffering from complaints peculiar to them, will find warm bathing, 
when wisely indulged in, grateful and beneficial. For persons vigorous 
and healthy, who find warm water a necessity for cleanliness, it should 
be merely an introduction to the cold shower-bath or complete immersion. 

The hot bath. The hot bath is a stimulant ; it accelerates the heart's 
action, distends the blood-vessels, and quickens the respiration. It pro- 
motes profuse perspiration, relaxes spasm and muscular rigidity, and, by 
drawing the blood from the internal organs, it is a powerful remedy in 
relieving them of congestion and functional disturbances due to imperfect 
circulation. By this method it is active in certain affections of the brain, 
induced by a distention of its blood-vessels. Simple fevers due to expo- 
sure, in their commencing stages, can often be arrested by stimulating and 



BATHING. 

relieving the activity of the skin. In scarlet fever and measles no Letter 
treatment than hot bathing twice daily can be instituted to develop the 
eruptions, liven the foot-bath has merits, doubtless known to all. 

Unless some especial reason exists for prolonging them, hot baths 
should net be protracted. After the stimulating effect of heat, debility 
follows. 

shower-bath. This is a familiar attachment to bathing conve- 
niences, and one too seldom employed. It is of value, and, if properly 
arranged, stimulation is secured without great shock. The water should 
fall from a moderate height, and pass through a large number of very 
small holes. If the arrangement is such that both hot and cold water can 
be used, it is rendered more agreeable and efficacious. The bather can 
apply soap freely, if needed, and under the hot shower cleanse the body 
thoroughly. The pores being opened, and while the glands of the skin are 
stimulated to greater activity, the stream can be instantly changed from 
hot to cold, and an invigorating re-action will follow the momentary shock. 
When warm water is employed for cleanliness by people in good health, 
the cold shower-bath, or the application of cold water in some form, should 
fodow ; otherwise the bather is extremely liable to take cold. 

The sltz bath. This form of bath is often advised by physicians, espe- 
ciallv for ladies suffering from irreorilarities and painful attacks common to 
their sex. Very rarely will be seen a tub constructed for the purpose. 
Generally a common wash-tub is used, and found extremely inconvenient. 
The half-bath can be substituted for such unsuitable contrivances. In this 
the bather sits in water to the depth of about twelve inches. Some 
invalids affected with lung disorders are unable to bear complete immer- 
sion, by reason of a difficulty in breathing, caused by the pressure of the 
water upon the surface of the body. This force has been estimated as a 
pound to the square inch. For such unfortunates the half-bath is adapted, 
a sponge being used on the upper parts. 

Th.e vapor lath. This bath should rarely if ever be indulged in ex- 
cepting when acting under the advice of a physician. To those who suffer 
from heart irregularities, or affections of the head induced by over-disten- 
tion of the blood-vessels, it is especially forbidden. A simple vapor bath 
can easily be administered if needed, after much the same method as the 
old fashioned "rum sweatings. " The individual, placed in a chair, should 
be surrounded by a water-proof covering fitting closely at the neck. 
Steam is then generated within this tent-like contrivance by pouring 
water on hot bricks, or by dropping hot stones into a tub or dish con- 
taining but a few inches of water. At first the breathing is oppressed and 
general discomfort felt. The unpleasant sensations are soon dissipated 
when the pores are opened and perspiration is induced. In the Russian 
baths vapor is the essential. It has been said of the people from whom 
the name takes its origin that they, in former times, were accustomed to 



THE VAPOR BATH. 99 

expose themselves to an almost unbearable heat, and then, naked and steam- 
ing, rush out and roll in the snow. In the Turkish bath the atmosphere 
is dry, differing essentially from the Russian bath, in which the air is 
loaded with moisture. In the former, the bather disrobes in the outer 
or "cooling room" and passes into the " tepidarium," the temperature of 
which is usually from 130° to 140°. The heat there encountered is at 
first oppressive, but after a few moments it is easily borne. The ful- 
ness of the head, if persistent, can be relieved by the application of cloths 
saturated with cold water. In this room perspiration is excited and when 
active the bather passes into the "calidarium," the temperature of which 
is 140° to 180°, and sometimes higher. Here the operations kneading 
and shampooing are performed, soap being freely used; and in many 
establishments, flesh-brushes or bundles of fine wood-fibres are employed 
with hard rubbing. The next room entered is the " lavatorium," where a 
shower-bath of warm water, changed gradually to cold, washes the body. 
The cooling-room, or " frigidarium," is then reached, and there the bather, 
wrapped in a sheet, reclines until the body is thoroughly dried, and he 
then dresses slowly, as renewed perspiration is easily excited by effort. 

Turkish baths are refreshing and invigorating ; one leaves them with 
lighter step and more buoyant spirit. It is unwise to remain long exposed 
to the high temperature, or too often indulge in them. When used in 
moderation, they are safe and of great benefit. 

Sea-bathing has merits no other form possesses. The surroundings are 
more cheerful; by many they are enjoyed when free from care and absent 
from accustomed duties. This mental influence is strongly felt, and added 
to it are others, the low temperature of the water and the gentle shock 
of the waves. Bathing in the sea should be denied all to whom cold baths 
are forbidden. The vigorous can safely bathe daily ; the less strong, not 
oftener than on alternate days. An hour before noon is the best time to 
indulge. The water should not be entered hesitatingly, but a bold plunge 
taken at once. The more courageous will do well to dive. The average 
duration of the bath should be from five to ten minutes for children, fifteen 
minutes for women, and but little longer for men. To delay much beyond 
these periods is a pernicious practice, inviting debility and injury. On 
leaving the water, friction with a coarse towel should be employed, and, 
after dressing quickly, a brisk walk for a short distance should be taken. 

A danger to the hearing power exists in sea-bathing, which, however 
slight, is deserving of mention. After diving or when the head has been 
submerged and the nasal passages are filled with water, bathers will fre- 
quently make violent expulsive efforts to clear them, by closing first one 
nostril and then the other. The danger is that in so doing they sometimes 
force water from the back part of the passage up the tube to the middle 
ear, causing a "crackling sensation" and laying the foundation for 
catarrhal inflammation. By taking a deep inspiration, suddenly closing 



100 BATHING. 

the month and expelling the air through the nose, it will be equally as 
■ ual, and the danger referred to will be obviated. 

In all forms of bathing certain precautions should be observed. Several 
hours after eating, three or four at least, should pass before the water is 
red. Generally, the morning, on arising, is the proper time. The 
too free use of soaps is injurious to the skin, rendering it dry and sensi- 
tive. After all baths the surface of the body should be thoroughly dried; 
following the application of cold, friction should be prolonged until the 
skin is heated and reddened. By it circulation is equalized, and health 
and vigor are promoted. 



CHAPTER VI. 
CLOTHING. 

The object of clothing is to maintain the body at that degree of tem- 
perature which is most agreeable, and suited to the healthy performance 
of the different functions. It acts as a shield in winter by stopping 
waste of the bodily warmth, and in summer by preventing the absorption 
of heat. The material through which heat is transmitted with the greatest 
difficulty is the most efficacious for the purpose of clothing. In its selec- 
tion other properties are to be considered : that it is not uncomfortable by 
reason of great weight, and does not obstruct free and easy movements of 
the body and limbs ; that it does not increase perspiration in an unneces- 
sary degree, and that by it the moisture of the atmosphere is not too much 
absorbed. ■ 

Woollen fabrics take precedence as bad conductors of heat. Next in 
essential properties come materials of silk and cotton, and those of linen 
are to be considered last. 

Water is a better conductor of heat than air, and damp clothes are a 
source of danger, for the reason that they rapidly transmit the heat of the 
body, and the evaporation of their absorbed moisture cools the surface and 
tends to reduce bodily temperature below the normal degree. In the most 
uncomfortable, chilling weather, when the cold seems penetrating, the air 
is loaded with moisture ; this is absorbed by the clothing, which then more 
rapidly conducts away the heat of the body. Linen takes up the perspira- 
tory fluid, parts with it quickly, and by evaporation lowers the bodily 
temperature. This is one reason why it is so often chosen for the 
hottest weather. While cotton absorbs less moisture, and heat is more 
slowly transmitted by it than linen, wool and silk are still poorer con- 
ductors. 

The absorbent power of wool is said to be double that of cotton or 
linen in proportion to its weight, and quadruple in proportion to its 
surface. Its fibres take up water and are distended by it; they also admit 
of its interposition between them. If woollen fabrics are used during 
exercise and while sweating freely, the vapor of the perspiration is con- 
densed in the clothing, from which a great amount of heat is again given 

101 



10:2 CLOTHING. 

to the body. If cotton or linen is worn, the perspiration passes through 
them and evaporates on the outer surface without condensation, and by 
this means bodily warmth is withdrawn. For this reason dry woollen 
clothing- after exertion is far more agreeable, and when used there is less 
danger from chilling. The texture of wool adds to its warmth. Materials 
loosely woven are warmer than those of closer fabrication. The air con- 
fined in the inter-spaces is itself a non-conductor, acting as such in the 
same manner as when enclosed between double windows. 

It is evident that as a protection against cold, woollen fabrics are supe- 
rior to either cotton or linen, and should be worn as underclothing. Very 
many object to their use as inner garments on account of the coarseness of 
texture, and the excitement, if not irritation, of the skin which is induced. 
Those of silk are decidedly the most agreeable ; by reason of cost, few can 
indulge in them. It is therefore advised that cotton underclothing be 
worn next to the skin. 

In winter, when the body is well protected by sufficient clothing, free 
exercise easily and speedily induces perspiration. This is increased by 
woollen fabrics worn next to the body, and by ready absorption of the fluid 
they soon become damp, uncomfortable, and unsafe. If cotton is inter- 
posed, this objection is obviated. Not only will the body become less 
quickly uncomfortably heated, but also will the perspiration be absorbed by 
the cotton, and the woollen covering remain dry and a better protection. 
Again, two layers of clothing are warmer than a single layer containing 
the same amount of material. With cotton between flannel and the skin, 
the cold penetrates less easily, the body is less quickly sensible of sudden 
changes, the most common cause of chills and cold. 

Many will feel distrustful of this innovation in dress; none who have 
accepted it can ever be persuaded to dispense in winter with cotton under- 
garments. They need not be cumbersome or heavy; ladies can, if they 
choose, employ the "gauze" underwear. For men the material known as 
"cotton-flannel" is advised; the upper garment should be made with the 
softer surface inside. It may be quite closely fitting, especially about the 
neck, short, and without sleeves, to admit of free and unrestrained move- 
ments of the arms. For convenience in changing, it should be made to 
button in front. While it is better that the entire body in winter should 
be encased in cotton, the undervest is by far the most essential. 

Boerhaave once said: "Only fools and beggars suffer from cold, the 
latter not being able to secure sufficient clothes, the former not having the 
sense to wear them." Few will accept this as an axiom, and yet its truth 
i- self-evident. It is not uncommon to hear persons boasting of their 
hardihood, seemingly vain in the assertion that summer and winter alike 
they never wear underclothing. These people certainly are exceptions; 
they appear to have set at defiance Nature's laws, and live in violation 
with seeming impunity. While one among them sees old age, habits such 



PROPER UNDERCLOTHING. 103 

as theirs have sent a hundred others to early graves. It is with reluctance 
the statement is made, and yet truth sustains the assertion, that women 
generally show too little regard for health in the selection of their under- 
garments. Ignorance may be palliation for some, but for others there is 
no reasonable excuse; they knowingly outrage the laws of physical being, 
and few escape the penalty. When the family physician urges the lady of 
fashion to wear undervests of sufficient weight to be protective, too often 
is he met with the reply that compliance is absolutely impossible, as it 
would make her look stouter, and her dresses could not be buttoned were 
even one additional thickness of clothing worn. Few can be induced to 
clothe the lower limbs properly ; some will wear thin cotton, but both that 
and flannel are rarely considered necessary. The arrangement of women's 
clothing is generally such that the limbs and lower parts of their bodies 
suffer most from cold and damp, and by this exposure many ailments and 
derangements peculiar to the sex are propagated. The fashion which dis- 
placed and abolished the "crinoline" made a step towards reform. Under 
it the moisture of wet and muddy streets accumulated, to be absorbed by 
the clothing, promoting local disorders and general infirmities. 

As a protection against cold, woollen undergarments should be worn 
over the inner covering of cotton. The requisite thickness and weight of 
the former must be regulated by individual needs. Less robust men and 
women, in very cold weather, can hardly walk fast enough to excite 
increased action of the functions sufficient to develop unusual bodily 
warmth and thereby promote comfort. The piercing winds chill the body, 
lower the temperature, and the powers are too feeble to supply the loss of 
heat. All who suffer impairment of health should wear clothing in keep- 
ing with their conditions. Women, during winter, when devoted to 
domestic duties, find both woollen and cotton worn over the lower limbs 
disagreeably heating. While at home and in comfortably warm houses, 
the former may be laid aside. Before venturing into the cold air, the 
woollen garment should invariably be resumed. This article of clothing for 
the lower limbs should be of flannel, not too fine or too coarse in texture. 
Loosely fitting, it can be made to button below the knee, and should be so 
fashioned that for cold air to reach the parts it is intended to protect will 
be impossible. 

Ladies prominent in America as identified with "dress reform" have 
recently devised methods of improvement in the underclothing for their 
sex. As advised by them, the under flannel vest and drawers, united in 
one piece, are knit from the best of threads, and can be found in silk, wool, 
or merino, each in light, medium, or heavy weights, as preferred. There 
can also be obtained a lisle-thread, or gauze, and a heavy cotton garment 
for those who wish it. It is said that those who have enjoyed the comfort 
of a "jersey waist" will appreciate the exquisite freedom which under- 
clothing of this sort affords. The fit is perfect, yet the soft, elastic fabric 



104 CLOTHING. 

yields to every motion of the wearer, and an even warmth is afforded, from 
neck down to the ankles and wrists. 

This effort towards reform is certainly to be commended. The under- 
clothing can no longer be complained of as clumsy and grievous to be 
borne, but, by proper shape and material, the prime object of such clothing 
is secured. There is freedom of movement, warmth is equally distributed, 
and comfort promoted. 

While discussing the subject of woman's dress, it is pertinent to briefly 
consider the manner in which their clothing is fashioned, with reference to 
its influence upon the general health. More than four score of years ago a 
then prominent author said : " The unnatural and unnecessary practice of 
tight lacing is, it is to be hoped, fast declining and falling into disuse." 
He cannot in this age be considered a true prophet ; the decline has been 
too gradual, and the custom is by no means obsolete. Slowly as reform 
has advanced, yet its progress can be traced. The stiff stays have been 
displaced by the more comfortable well-fitting corset ; the tight lacing 
unfortunately exists, a relic of the past. He who would inveigh against 
the corset would be indeed a bold man, and his attacks upon it 
would earn for him the exj^erience of Don Quixote. So uniformly 
endorsed by women, by them claimed a necessary support, it must be 
accepted as essential to the proper adjustment of their clothing, and 
to bodily comfort. To its advocates be it said, Use, but not abuse it. 
Wear it if you will, but let it fit you loosely. The ribs should not be com- 
pressed and free expansion of the lungs prevented. The dangerous conse- 
quences of pressure on the abdominal organs are many. The performance 
of their functions is interfered with ; they are displaced from their normal 
positions; derangements and irreparable disease follow. Under tight 
lacing circulation suffers severely, pressure on the vessels of the skin 
reduces their capacity ; the blood is forced to the internal organs and 
brain, and in them congestive disorders are invited. The action of the 
heart becomes forced and irregular, palpitation is induced, and feelings of 
oppression are often followed by attacks of fainting. More remote results 
of this pernicious custom are destruction of natural ease and elegance of 
form, general disorders, and local infirmities, such as displacements and 
functional irregularities. 

The weight of the clothing worn by women should be borne by the 
hips, and not by the shoulders. Commenting on a letter from Dr. Horace 
Dobell in the London Times, concerning the bad effects of the "braces 
system of suspension " for women's dress, in which he urges that the hips, 
and not the shoulders, are the best part of the human frame for the support 
of weight, on the ground that braces restrict the elevation and antero- 
posterior expansion of the chest-movements, even more important, as the 
writer justly observes, to women than to men, the BritisJi Jledical Journal 
agrees that there is much 'ruth in these remarks. It trusts, however, "that 



DRESS REFORM. 105 

the assertion that the system of suspension of the clothes from the 
shoulders is the outcome of the arguments used by 'dress reformers' 
against tight lacing, will not be seized by the ladies as a statement in favor 
of continuing the use of stays. The evils referred to by Dr. Dobell doubt- 
less are often produced by the use of braces, and especially when a heavy 
weight is suspended. This weight is often unnecessarily great, in conse- 
quence of the looseness of ladies' clothing. If, instead of hanging a 
quantity of loose clothes round the legs, the garments covering these 
extremities were chiefly close fitting, the weight of the clothing might be 
very much lessened, because, when close to the body, they preserve the 
warmth much better than when surrounding the legs loosely. The principle 
of dual garments might be carried on without altering the external appear- 
ance of female dress; for, with the use of warm, close-fitting drawers or 
trousers, the outer skirts might be made in the usual manner, but of much 
less thickness and weight. Many ladies now wear neither stays nor sus- 
penders, and yet experience no difficulty in supporting their skirts, chiefly 
upon the hips." 

The Boston Medical and Surgical Journal adds : " We have long 
thought that, in their zeal against tight lacing, our 'dress reformers' were 
doing society a disservice in decrying the moderate use of stays, and were 
likely to provide the profession with a crop of evils resulting from their 
contrivances, quite as formidable as any hitherto traced to the abuse of 
corsets. The thoracic organs are quite as worthy of fair play as the 
abdominal." 

Skirts made of felt, or similar compressed and compact material, are 
decidedly objectionable, by reason of their great weight; they are less 
protection against cold than lighter fabrics of more open texture. 

To the comments on women's fashions the statement may properly be 
added that rigid adherence to the mode is often complied with to avoid 
ridicule, but, if this obedience be prejudicial to natural vigor, it is an 
evidence of unpardonable weakness. For the preservation of health atten- 
tion to the clothing is indispensable. Those of feebler constitutions should 
know that they, by observance of salutary precepts, will be longer in the 
enjoyment of life than those of strong bodies whose weak minds suffer 
them to ignore Nature's laws. 

That the clothing of men should be large enough to permit every 
movement of the body to be made with ease, is 'an injunction which 
applies alike to them and to women. Reform need not be idle among the 
sterner sex. Growing corpulency can only be disguised by unhealthy 
restraint ; bodily discomfort is the penalty imposed for the observance of 
many of Fashion's demands. The tight and contracting pantaloons display 
a shapely leg, yet are extremely inconvenient ; they disturb circulation by 
pressure, and prevent active movements. The exquisite who courts 
strangulation in the collar of the period, prevents easy flow of blood to 



CLOTHT3 

from the brain, rentiers himself uncomfortable, and bis movements 

awkward. It lias been well said that while we have rejected all coTerii gs 

hildren as being tr s me and as bs, ; t, in defiance 

- a and exj . we continue to encumber our own necks with 

lages. The neck and throat being constantly in use, it is 

highly imprudent to obstruct motion for the sake of appearance, vanity, 

n. All cover: _- _'.t to be worn sely. The shirt should be 

comfortably high in front, and the form of collar chosen which is 

ible. Practically, the collar and necktie will be sufficient 
d for the throat. The fashionable neck-handkerchiefs are abomi- 
nations; they overheat the parts they cover, and render them unnaturally 
Bensil y change of the atmosphere. AVhen the cold is intense, 

turning up the coat-collar will be sufficient additional protection. 

ho are subject to sore throats especially — all others may wisely 
a Tve this rule — should select one fashion of collar and necktie early in 
the autumn, and vary little or none from it until late in the spring. Their 
shir- si Iso be uniformly fitted about the neck: frequent changes 

from the standing to the turn-down collar are a common cause of throat 
affections and catarrhal dis rdera. 

A- _ neral rule, men will do well to wear warmer underclothing and 
lighter c ts: se can then be more freely indulged in. The overcoat 

should be loosely fitting, as ?asy icross the chest when buttoned as when 
unbuttoned. Long ■■•:• oat-skirt s" seriously interfere with walking, and are 
but little protection agaii st Id, certainly not sufficient to compensat 
their inconvenience. Those men who are obliged to take long drives in 
winter will do well to provide themselves with a large cape, of coarse 
material, lined with flannel. If the same be provided with a large collar, 
no more comfortable garment can be imagined. It can be marie with 
openings on the sides, through which the arms can be passed for driving. 

It will, perhaps, lend interest : : the subject of clothing if the f 

ing general rules are added : Leave off your winter clothes late in the 

_ and put them on early in the autumn. Clothes should be warm 

enough to protect the body against large mough to permit every 

movement to be made with as much ease when they are on as when they 

are off. When leaving the cold air and entering warm rooms, remove the 

ipe at once. If ladies would observe this rule, colds would be 

common among them. They too often visit churches and pi res : 

arm- there remain for a time in their costumes entire. On 

leaving they enter their carriages or the street-cars, and reach home el : 

and shivering. It would 1 isd n all such occasions, when suddenly 

leaving a high temperature and entering a much low r alk until the 

sd 1 'he change, and circulation is active. 

languid circulation, the cause of chilliness feet, the best 

treatment is exerch . A walk of twenty minutes in the open air three or 



POISONOUS DYES. 107 

four times a day Avill be mainly instrumental in the accomplishment of a 
cure. Weak people, who in very eold weather cannot walk fast enough to 
exeite sufficiently increased action in their systems to make and keep them- 
selves warm, will do well, just before starting, to drink a small quantity of 
hot broth or tea to stimulate circulation. 

The non-conducting power of woollen fabrics lessens under continual 
washing; the soft fibres shrink, become harder, and less absorbent. In 
washing woollen articles, they should never be rubbed or wrung. They 
should be immersed in hot soap-suds, moved about, and then plunged into 
cold water; when the soap is entirely removed, they should be hung up to 
dry without wringing. 

In the coloring of clothing there are sometimes used certain dye mate- 
rials which cause irritation, and occasionally disease of the skin. These 
are frequently detected in the different shades of red. In Xew York 
recently a noted chemist purchased samples of red and cardinal colored 
stockings at a dozen stores. They w T ere of cotton, and analyses were made 
which proved that, in four cases, tartar-emetic was used to fix the dye 
known as saffronine, thus rendering the stockings poisonous. Traces of 
arsenic were found in others. 

In concluding the subject of clothing, a word of encouragement to 
those who cannot be considered robust. To them be it said, "If you are 
careful of it, glass will last as long as iron." Long life is not necessarily 
connected with high health ; many of weakly constitutions have attained 
very advanced age by unremitting attentions to physical requirements, 
which to the vigorous seem trifling. 



CHAPTER VII. 
CARE OF THE MOUTH. 

Affections of the mouth are by no means uncommon ; some of them 
are doubtless induced by habits born of thoughtlessness, and, it is to be 
feared, vulgarity as well. If those who occasionally place coins in their 
mouths could see how carefully a physician disinfects his hands, and even 
the money taken from certain of his patients, they would never again be 
guilty of that most atrocious custom. Common decency demands that 
the mouth be restricted to the purpose for which Nature intended it, and 
the hands be allowed to do their work unaided by it. The business 
man who receives a letter with a stamp enclosed and attached to the 
corner, should be very careful, when he mails his reply, that his own lips do 
not moisten that stamp, so recently at the lips of another and, possibly, a 
perfect stranger. Contagion is very easy of transmission : its germs are 
everywhere. The hands of all, both clean and filthy, touch many things 
in common. One should therefore be extremely careful, after such contact, 
not to carry the fingers to the mouth. One author has very wisely said, 
•• Trie only safe rule, in fact, is to be as careful of the hands as if one were 
a dentist; never to put them near the mouth without having first washed 
them." This precaution entails some trouble, and yet it may often avert 
the evil consequences which follow contagion. 

The natural tendency of infants to put everything into their mouths 
which they can hold in their hands, must impress upon mothers the need 
of watchfulness. While referring to children, it is well to allude to that 
most abominable habit which mothers often teach their little ones, to give 
and expect kisses from every intimate. They really endanger both their 
children and those upon whom the tribute is bestowed. The older persons 
may be afflicted with some disorders known only to themselves, and in the 
child may lurk the poison of incipient disease. A former physician of 
B -ton paid a terrible penalty for his most absurd custom of kissing the 
children he was called upon to attend. In a moment of thoughtlessness 
he bent over a little sufferer ill with diphtheria and bestowed his usual 
caress. Her disease was of the most malignant type: he received from 
her the germs of contagion, and in less than forty-eight hours he died with 
the same dread malady. 

108 



CARE OF THE TEETH. 109 

Doubtless there are many people who were unable to realize the impor- 
tance of wisely caring for the teeth, until pain and decny had deprived 

them of at least one, or more. A discussion of the subject may without 
impropriety be prefaced with an allusion to certain fancies which possess 
many mothers while children are cutting their first teeth. During the 
period, which, in some instances, commences as early as the second month 
of existence, and ends when all the finst teeth have appeared, many 
mothers are inclined to attribute every infantile derangement and disorder 
to dentition. Attacks of colic, indigestion, fevers following exposure, and 
the numberless ills the little ones are subjected to, are too often ascribed 
to that maternal bugbear, "teething." The consequence is sad results not 
infrequently follow this ready and erroneous assumption. There are few 
physicians who cannot recall cases of malignant diseases to which they 
were called too late, and in which recovery might have taken place had not 
the credulity of the mothers rendered them incapable of recognizing the 
dangers. 

During the so-called teething period there is no especial predisposition 
to disease, but the system then is in a condition which invites, as it were, 
associate disorders and complications. Many of the complaints which 
attack teething children are merely accidental ; that is, they are in no wise 
dependent upon dentition. To render the statement more intelligible, 
convulsions are selected as an illustration. They are never induced 
by teething, but while that process is going on the nervous system is 
in such a condition convulsions are easily excited by other influences. 
Rarely, however, will they occur in a teething child unless there is sluggish 
digestion, and some constipation is associated ; these derangements are 
then the influences which incite the convulsions. 

The same may be said of many other general disorders so frequently 
accompanying dentition ; they find the system less able to resist them, and 
the child is more easily attacked. It is important, then, that mothers be 
taught to look upon teething as a natural, not a diseased process ; that 
during its period, if symptoms of disease are manifested, they should look 
beyond it for the active or exciting cause of the infant's suffering or com- 
plaint. 

M. Delabarre affirmed that by an inspection of the teeth can be ascer- 
tained whether the innate constitution is £ od or bad. If a child is 
healthy and strong, the teeth partake of the health of the organism gener- 
ally. If other parts of the body are innately delicate or imperfectly 
developed, they may afterwards become firm and strong. The teeth are 
not governed by the same laws, either physical or vital, that regulate the 
operations of the other parts of the animal economy. The other tissues of 
the body, not excepting the bony structures, are endowed with recupera- 
tive powers, whereby an injury is repaired by their own inherent energies, 
but the teeth do not possess such attributes. 



110 CARE OF THE MOUTH. 

The care of the teeth should begin in childhood. If they become 
affected :nid show sign a of degeneration before a certain age, it is evidence 
that there exist certain constitutional defects and derangements, a fact to 
which sufficient importance is rarely attached. Although the disorders may 
be overcome, and perfect bodily health in later life be enjoyed, the teeth, 
which suffered from the general weakness and ill health, can never reach 
that perfect condition the other parts of the body without exception may 
attain. 

If the teeth of a child become affected, not only should the cause be 
sought for in the general health, but the duty of parents demands that 
every effort should be made to preserve them from destruction. While 
some teeth are irretrievably ruined before certain varieties of decay are 
suspected, habits of cleanliness will do much to arrest disease and aid in 
their preservation. 

Children should be taught to be scrupulously exact in care of their teeth. 
A soft brush ought to be used by them after each meal, before retiring, 
and at their morning toilet. Should signs of decay appear, or tendency to 
deformity be noticed, then they ought at once to be placed under the care 
of a dentist, that important professional so rarely sought, by certain classes 
at least, excepting when extraction becomes imperative. 

The same habits of cleanliness enjoined upon children should be 
observed by adults. If their teeth are well formed and well arranged, all 
that will be required is to keep them clean. For cleaning the teeth, when 
they are in sound condition and free from accumulations, the gums are 
healthy and the secretions of the mouth normal in character, the frequent 
use of pure water by the means of a soft brush will in most cases be suf- 
ficient. A waxed silk thread, to pass between the teeth, will aid in cleaning 
the edges, and remove deposits between them. If the teeth are stained and 
discolored, and tartar is deposited, then the employment of tooth-powder 
is necessary. The word dentifrice is derived from two Latin words, dens. 
a tooth, and frico, to rub. The preparation to which the name is applied 
is medicinal, and in the form of a powder. The varieties are numberless, 
and many of them are highly injurious. 

A dentifrice should be anti-acid, agreeable to the taste, and of the 
simplest combination possible. Orris root, prepared chalk, and pure Castile 
soap are generally the best ingredients. If this does not remove the dis- 
colorations, and tartar forms, a little finely powdered pumice-stone may be 
added, and will prove quite sufficient. Soap alcne will not cleanse the 
teeth, for it prevents friction. Charcoal and cigar-ashes are injurious as 
dentifrices, for the reason that they enter between the gum and the tooth, 
causing the former to recede and leave the neck of the latter more 
exposed. 

An unhealthy condition of the gums is due to want of cleanliness, and 
frequently to the use of pernicious tooth-powders: after removing the 



EFFECT OF ACIDS ON THE TEETH. Ill 

cause, the tincture of myrrh will be efficacious as a mouth-wash ; two tea- 
spoonfuls can be added to a glass of water. 

In 184o experiments were made by Dr. A. Wescott to determine the 
action of certain fluids upon the teeth; the results arc highly instructive. 

They demonstrated that both vegetable and mineral acids act readily 
upon the bone and enamel. Vegetable substances have no effect upon the 
teeth until after fermentation takes place, but all such as are capable of 
acetic fermentation act readily after this acid is formed. Animal sub- 
stances, even Avhile in a state of confirmed putrefaction, act very tardily, 
if at all, upon either the bone or the enamel. 

The teeth are exposed to injurious agents ; their action and the conse- 
quent liability to be affected by them was shown by the experiments. It 
was proved that acetic acid, or common vinegar, in frequent use as a con- 
diment, and lemon-juice so corrode the enamel in forty-eight hours that 
much of it can be easily removed with the finger-nail. The muriatic, 
sulphuric, and nitric acids, in common use as tonics, though largely diluted, 
soon decompose the teeth. Sulphuric and nitric ethers have a similar 
deleterious effect, as also the spirits of nitre; these are medicinal remedies 
very frequently used in sickness. Raisins so corrode the enamel in twenty- 
four hours that its surface presents the appearance and is of the consist- 
ency of chalk. 

It will be seen from the foregoing that in all conditions of life the teeth 
are constantly exposed to agencies which induce decay. The fact that 
cleanliness contributes to their general health and preservation is not gen- 
erally appreciated. It is one of the surest means to protect them. Dr. 
Parmly has said: "Where the teeth are kept literally clean, no disease will 
ever be perceptible. Their structure will equally stand the summer's heat 
and winter's cold, the changes of climate, the varieties of diet, and even 
the diseases to which the other parts of the body may be subject from 
constitutional causes." 



CHAPTER VIII. 
CARE OP THE HAIR. 

The management of the hair is a subject of some importance, the 
extent of which is not generally estimated. Perfect cleanliness of the 
head contributes largely to health and comfort. A proper care of the hair 
obviates certain diseases, and will, in a measure, delay the appearance of 
those evidences which testify to age and decay. The oil-glands of the 
scalp are especially active ; the smooth and glossy condition of the hairs is 
due to the fluid secreted by them. When these glands are inactive the 
hairs become dry and brittle, are easily split or broken off, and finally 
cease growing altogether. Dust and floating particles readily cling to the 
hairs, and germs of disease are not infrequently deposited among them. 
The surface of the scalp becomes more or less charged with exfoliations, 
which ought to be daily removed. The process by which they are dis- 
placed stimulates not only the circulation in the scalp but also the growth 
of the hair. Frequent and thorough brushing is the most suitable and 
convenient method of keeping the head clean and the hah- in good condi- 
tion. The oil-glands are occasionally inactive, and insufficient fluid is 
secreted by them ; for this condition pomades are commonly employed to 
counteract the dryness of the hair. By persistent use of a soft brush the 
glands will renew their activity, and oily dressings can be dispensed with. 
The habit of thoroughly wetting the head every morning and then rubbing 
it briskly with a towel until dried, can be enjoyed by those who wear 
short hair; under no conditition should they venture out of doors in 
cold weather until friction has removed every trace of the moisture. 

Under ordinary circumstances, frequent brushing, with occasionally 
bathing the head, will be quite sufficient to keep the scalp and hair clean 
and in good condition. Travellers and others exposed by occupation to 
dust and dirt can only secure perfect cleanliness of the head by thorough 
washing. By them toilet soaps of the first quality should be used. 
Occasionally the oil-glands are too active, and the scalp and hair appear 
loaded with the fluid ; in such cases the stronger alkaline soaps will be 
needed. 

112 



CLEANSING THE HEAD. 113 

In some persons thin scales accumulate on the scalp, occasioning much 
annoyance. This condition is often induced by the use of fine combs, and 
sometimes by the finger-nails. To remove it a solution of borax and water 
is commonly employed. The "whites" of raw eggs make an excellent 
shampoo, and may be rubbed freely into the hair. A tablespoonful of 
aqua ammonia added to a basin of water is also very efficient. 

This affection of the scalp is evidently of an inflammatory character, 
being accompanied by considerable congestion. The fine scales are thrown 
off by a process of inflammation, which is attended with burning or itching. 
It is not confined to those in whom the hair is scanty, but more often 
affects those with abundant growth. The disease may be regarded as dis- 
tinct from seborrhcea, with which it is often confounded. 

Women with long and thick hair will naturally be disinclined to wash it 
oftener than cleanliness demands. For them to thoroughly dry it at once 
is compulsory ; if they do not, and the water is allowed to dry in the hair, 
the secretion of the oil-glands becomes decomposed, and a sour, extremely 
offensive odor is emitted. To assist in drying long hair after it has been 
carefully rubbed in towels, finely powdered starch can be taken up on a 
brush and then removed by continued brushing. Women will rarely need 
to use the fine-toothed comb; it can properly be entirely dispensed with. 
Coarse combs are required to prevent matting and to "part" the hair; 
they should be employed no more than is absolutely necessary, as they are 
liable to irritate the scalp and occasion troublesome disorders of it. 

The growth of the hair is hastened by cutting ; if not interfered with, 
the limit seems to be reached after a certain time. Cleanliness, comfort, 
and convenience urge that the hair of children, especially boys, be kept 
closely trimmed. It is unwise and in extremely bad taste to cultivate the 
long curls with which young lads are occasionally inflicted. 

The habit of plastering the hair to the forehead with bandoline and 
soaps is not only an abominable one, but also has occasionally provoked 
pernicious results, the hairs being discolored and their vitality lessened by 
the materials used. "Bangs" falling continually over the forehead in some 
people promote an irritation of the skin, recovery from which is often slow. 
"Crimping" the hair over hot irons, pencils, or pipe-stems ultimately 
causes it to become dry and brittle. In young girls, while the hair-follicles 
are active, the growth is soon restored, but matured women will do well to 
avoid all customs which endanger their hair and invite premature loss and 
baldness. 

The hairs are said to grow more rapidly in the day than at night, and 
quicker in w r arm than in cold seasons of the year. Each hair grows from 
a bulb contained in a follicle or sac in the skin. If not injured, the limit 
of growth is reached at a certain time; it then loses its vitality and drops 
out. This period of life in robust persons is estimated by some to be from 
two to four years. While the follicle remains healthy, it furnishes the 



114 i AUK OF THE HAIR. 

hair-bulb with materia] necessary to its growth, and new hairs continue to 
replace the old. The hair is simply a plant with a bulbous root, placed in 
- : ". favorable to its growth. At certain intervals the stalk ceases grow- 
ing, withers, and is broken off. From the same follicle another shoot is 
sent forth, to grow, mature, and, in turn, wither and disappear. 

tween the ages of thirty and forty the hair begins to thin out, and 
this process, in healthy persons, advances slowly and steadily during the 
rest of their lives. From various causes this thinning out of the hair may 
occur earlier in life, and premature baldness, partial or complete, result. 
The falling out of the hair in young persons is not generally preceded by 
grayiK-ss; the affection is often hereditary. The hairs come out first on 
the crown of the head, and there is associated an increased formation of 
scales; the skin becomes thinner and more tightly drawn. 

The hair falls out in consequence of internal diseases, such as typhoid 
and typhus fevers ; also after certain forms of blood-poisoning; disturbed 
nutrition is another and important influence. Alopecia is a loss of hair 
from local causes. Among the more common are diseases of the hair- 
follicles, of the oil-glands, parasites, and affections of the nerves. 

The affection commonly known as " dandruff " is, properly speaking, 
seborrhoea, which may affect any portion of the body, but usually attacks 
the head. The disease manifests itself in two forms, the oily and the dry. 
In the former the secretion of the oil-glands accumulates on the scalp, and 
mingles with particles of dust and dirt, and with the scales which naturally 
are continually exfoliated. This mixed matter does not become detached 
and fall upon the clothing, but adheres together, surrounding the hairs and 
covering the scalp to a considerable depth. If this coating is not removed, 
the hair sooner or later is affected ; it becomes dry and lustreless as its 
vitality is impaired, and eventually falls out. The next step in the 
progress of the disease is a changed condition in the hair-follicle, it being 
rendered incapable of further production. After this point is reached the 
renewal of the hair is impossible. 

Seborrhoea may affect people in perfect health, but those suffering from 
it are usually below the standard. The course which it runs is exceedingly 
variable. At times it manifests itself in a mild form, and readily dis- 
appears under proper treatment. In other instances it is very severe and 

-: stent, and. while improvement seems to follow the use of remedies, 
relapses are not infrequent. It is an extremely annoying disorder, attract- 
ing" attention after the hair falls, and itching is quite constant and dis- 
tressing. Seborrhoea may appear at any time in life, and continue until 
middle age; rarely does it persist after that period is reached. In new- 
born children a greasy deposit covers the entire body; this substance is a 
modification of the natural secretion of the oil-glands. Xot infrequently 
nurses, by reason of neglect or ignorance, fail to wash the heads of infants 
properly during the first days of their existence. The matter which should 



DISEASES OF THE SCALP. 115 

have been removed goes on accumulating, dust and dirt are intermingled, 
it grows discolored and thicker. It eventually forms into a crust, which 
interferes with the natural action of the oil-glands, and underneath it their 
product by the action of heat is decomposed. This altered secretion is 
irritating, and congestion of the scalp is caused by it. If the crusty 
matter is not then removed, superficial ulcerations follow, and the disease 
known as eczema is propagated and generally spreads to parts until then 
unaffected. It is apparent that neglect in washing new-born children is 
followed by very troublesome results. 

When oily matters have accumulated on the scalp, and removal of them 
by the ordinary toilet-bath is impossible, or when the scalp is covered by 
dry scales unmixed with oil, it is well to use freely an oily preparation to 
soften and render the displacement of the deposit easier. Sweet-oil applied 
with a small piece of coarse flannel for half an hour is generally sufficient. 
Following this application, strong alkaline soaps should be used. The 
domestic "soft-soap," or the "green-soap" for sale by druggists, are appro- 
priate if properly diluted. To two parts of the former one part of alcohol 
should be added. The "green-soap" being much the stronger, with one 
part of it three or four of alcohol ought to be mixed. In using these 
soaps it will be well to cleanse one portion of the scalp after another. A 
flannel cloth can be employed to rub them into a spot the size of the hand ; 
it should then be dipped in water and again used to make a foam. The 
rubbing should be persisted in, and the cloth occasionally dipped until 
no more lather can be made. Another spot should then be cleaned in 
the same manner, and so on until all parts of the scalp have been 
covered. Finally, clear water should be used in sufficient quantity to 
remove all traces of the soaps, and the hair carefully dried by means of soft 
towels. 

If perfect cleanliness is insured, the affection in many instances will 
disappear. Occasionally medicinal applications are demanded. An oint- 
ment made of precipitated sulphur and salicylic acid, each half a drachm, 
and vaseline, one ounce, is very efficacious. It should be thoroughly 
rubbed into the scalp on retiring, and washed off on the following 
morning; a flannel or silk cap can be worn to protect the pillow- 
cases. This ointment should be used every night for a time, and then 
at intervals gradually lengthened, but persisted in for weeks and months 
if necessary, and discontinued only after recovery is completed. 

Continual washing causes the hair and scalp to become dry and harsh. 
The application of some oily substance is necessarily a part of the treat- 
ment. If the scalp is irritated, pure vaseline, or glycerine and rose-water, 
one part to four, constitutes an excellent preparation. If no irritation 
exists, an agreeable combination is castor-oil and cologne water, one 
drachm of the former to two ounces of the latter. The loss of hair may 
render treatment to promote its renewal necessary. The tincture of can- 



116 CARE OF THE HAIR. 

tharides is an agent o( value to stimulate the growth, and six drachms 
of it may be added to the mixture of castor-oil and cologne water. 

It is to be remembered that, while seborrhoea may occur in healthy 
persons, generally those who are affected suffer from some disease or func- 
tional disturbance of some of the organs of the body. In such cases the 
advice of a physician should be sought, and treatment employed to 
overcome all derangements and tone up the system to the standard of 
health. 

The term alopecia is expressive of a condition of more or less com- 
plete baldness, resulting from a deficient growth of the hair, irrespective of 
cause. The varieties of alopecia are many ; partial or entire absence of 
hair may be congenital, the manifestation of old age, the result of specific 
blood-poisoning, impaired nutrition, nervous derangements, seborrhoea, 
parasites, and numberless other exciting influences and disorders. 

One of the most frequent affections of the scalp, and the most common 
cause of premature baldness, is alopecia furfuracea. This disease comes 
on insidiously, and in its early stages is rarely recognized, — at least its 
significance is seldom appreciated until the loss of hair renders its presence 
plainly evident. It may make its appearance at any time after the age of 
fifteen, rarely before that period of life. At first only a few fine, insignifi- 
cant scales are noticeable ; these slowly grow more abundant, and in time 
the entire scalp is quite uniformly affected with this scaling-off process. 
After six or seven years the daily loss of hair becomes sufficient to attract 
the individual's attention. Pie realizes then, if he has not before, that his 
hair has thinned on the top of his head and forehead. 

The hairs at first cast off are replaced immediately by those of a shorter, 
finer growth; these in turn are shed and succeeded by finer hairs, and so 
the disease goes on, until the process of renewal finally ceases. Occasion- 
ally the affection is arrested and improvement seems to follow. This is 
rarely permanent, and baldness is the common consequence. 

Even in the early stages the disease becomes annoying and unsightly, 
by reason of the white, dry, flour-like scales which cover the hair and are 
continually being deposited on the coat-collar and shoulders of the indi- 
vidual attacked. The affection is, at times, associated with other disorders 
of the scalp ; seborrhoea not infrequently accompanies it. 

In the first stages of alopecia furfuracea treatment may be made 
effective, unless an hereditary tendency exists, in which event much benefit 
cannot, with reason, be expected. After the hairs begin to fall out they 
can never be replaced with a normal growth. All that can be hoped for is 
to save the unaffected hairs and arrest the thinning-out process. This 
treatment is materially the same as that advised for seborrhoea. Cleanliness 
is to be insured by daily washings and the use of the strong soaps, and, after 
the hair is thoroughly dried, the ointment of sulphur and salicylic acid 
should be well rubbed in, and its use continued for a long time. 



DISEASE BY INOCULATION. 117 

Lassar and Bishop published experiments which go to show that the 
ordinary alopecia furfuracea is' an inoculable disease. The hairs which 
had fallen from the head of a patient suffering from this malady were 
mixed with vaseline and rubbed upon the skins of guinea-pigs and rabbits. 
The animals treated in this manner became bald, that is, lost their hair, in 
the regions of the body to which this mixture of diseased hair and vaseline 
had been applied. This condition of things began to be manifest about 
three weeks after the inunction had been made, and the loss of hair was 
attended with desquamation. Hairs taken from these animals and rubbed 
into other and healthy animals produced a like result." Further particulars 
upon this subject were given by Lassar before the Berlin Medical Society. 
Two examples of this disease were exhibited to the society. Both the 
patients were young and exceptionally robust men, who for years had suf- 
fered from gradual and slowly increasing falling-out of the hair of the 
head, attended by some itching of the scalp and some desquamation 
thereof. Inoculation of hairs from the heads of these patients upon the 
skins of rabbits, guinea-pigs, and white mice had been sufficient to cause 
falling out of the hair in these animals. The above facts furnish ground 
for the assumption that this disease is locally infectious and inoculable. 
Opportunities for inoculation are furnished in plenty by the combs and 
brushes in use at barbers' shops, which, without any particular attention to 
cleanliness, are employed successively upon different customers. Women 
are less subject to this affection than men, by reason of the fact that, as a 
rule, they dress their own hair and do not frequent barbers' shops. 

A discussion herein of the many diseases of the hair and scalp is 
impossible, by limitation of space. It is neither essential, nor would it 
prove of value. Nearly all disorders attended by loss of hair are asso- 
ciated with or dependent upon constitutional affections or functional dis- 
turbances of the internal organs, for the treatment of which a physician 
must necessarily be employed. 

One reason why the diseases to which especial reference has been made 
have been selected, is because they are the most common. Again, they 
were thought necessary as illustrations to emphasize the dangers of neglect, 
and as arguments to influence the reader to anticipate annoying disorders 
of the scalp by greater care. 

The fact is apparent that, until threatened with loss, the exceeding 
value of that which should be cherished most is rarely appreciated. The 
truth of this assertion can be fully attested by those unfortunates who 
have suffered loss or diminution of sight, hearing, or other powers, which 
resulted in impairment of usefulness and embittered their lives. The 
person who has lost one eye can tell of the torturing anxiety constantly 
felt by him lest he be deprived of the other. 

A measure of regret must be the portion of all who sustain partial 
or complete loss of hair. To some the disfigurement is less annoying; to 



US CAKE OF THE HAIR. 

many it is grievously so. Few will, however, anticipate baldness by proper 
carefulness. Barbers assert that their patrons generally are neglectful of 
the scalp; want of cleanliness is observed there, while other parts of the 
body appear attentively eared for. In toilet-rooms, at hotels, in sleeping- 
coaches, and other places frequented by travellers, hair-brushes are provided, 
ami but few hesitate to use them. Through this medium diseases are 
conveyed ; parasitic affections are especially easy of transmission. In toilet- 
shops the barbers use brushes in common to all, and, while some persons 
are extremely fastidious about their shaving materials, providing their own 
cups and brushes, rarely will neatness and wisdom prompt them to procure 
as well combs and hair-brushes for individual use. The custom of having 
the head regularly shampooed is less common now than in years past. 
The reason for this is not evident ; the ingenious theory that sewer-gas is 
inhaled during the douching and while the head is bent forward over the 
bowl may have influenced some to forego the indulgence through fear of 
typhoid fever, or other diseases similarly induced. 

While discussing the subject, still further allusion to barbers is perti- 
nent. Xot by any means are they all personifications of nsatness. By 
many of them clean napkins for the head-rests of their chairs rarely dis- 
place those in use until begrimed and dirty. The cloth which envelops 
the occupant of the chair is passed between the collars and necks of one 
after another, until that too has become unclean and greasy. Thus it 
may be seen disease is easily transmitted in many of the public toilet- 
shops. 

Those who are unable to shave themselves will do well to use care in 
the selection of their barbers, and, if each patron cannot provide his own 
brush, it were wiser for him to dispense with the usual hair-dressing. 
Make the hair-brush as sacred to individual use as is the tooth-brush. 

For people in whom the hair is of abundant growth the occasional use 
of the so-called "sea-foam" shampoo will promote cleanliness. It is com- 
posed of the following ingredients, viz. : cologne water and aqua ammonia, 
each one ounce, alcohol, half a pint, and water, one pint. To use this 
preparation, moisten well the hair with it and rub briskly until evaporation 
is completed. 

Physicians are frequently consulted for a "hair-tonic," a preparation to 
preserve the hair and stimulate its growth. An efficient and very fragrant 
mixture can be made of the tincture of cantharides, two drachms, castor- 
oil, one ounce, alcohol, half a pint. To this the druggist should be directed 
to add a few drops each of the oils of bitter almonds, orange-flowers, and 
bergamot. 

Dyeing the hair is certainly a questionable procedure, and in exceed- 
ingly bad taste. The black dyes are generally used by men, and no per- 
nicious effects upon the system need be anticipated if the nitrate of silver 
is the principal ingredient. Its continued use, however, destroys the hair; 



DYES AND DEPILATORIES. ll'l 

it becomes dry and brittle. The dyes, cosmetics, and bleaching prepara- 
tions used occasionally by women cannot be too strongly condemned. 
Cases of poisonous absorption are not uncommon, and very often their 
application to the hair is followed by disastrous results. The writer was 
recently consulted by a woman who, not content with an abundant growth 
of rich chestnut hair, attempted the bleaching process, and the result was 
complete baldness. In a wig she now repents her rashness and folly. 

Abnormal growths of hair occasionally appear on the upper lips and 
chins of women, causing them much annoyance by reason of their unsight- 
liness. Cutting with scissors or razor stimulates the hair, and the disfig- 
urement becomes more evident. Extraction has a similar effect. Effectual 
methods of relief are now ]3ractised by specialists, but before consulting 
them the advice of the family physician should be sought. His knowledge 
of those who confine themselves to that branch of the profession will be a 
means of protection against the many ignorant pretenders. 



CHAPTER IX. 
CARE OF THE HANDS. 

The care of the hands demands a passing notice at least. In warm 
weather, little attention is required other than sufficient to promote clean- 
liness. During winter, however, imprudence is followed by much incon- 
venience and considerable suffering, for the reason that cold, dry winds 
tend to chap the hands. This occurrence can largely be prevented by 
proper care. Cold water should alone be used in washing the hands; 
soaps may be necessary to insure cleanliness, but they must be employed 
sparingly. It is unwise to bathe the hands just before leaving the house; 
if one is forced to do so, some oily preparation should be rubbed on the 
skin to prevent the action of the cold air. In winter, gloves are an 
absolute necessity, and those made of skins are preferable to woollen 
materials, being less liable to cause chapping. 

Many persons suffer much from the so-called "chaps," which appear on 
the hands and fingers, over those joints subject to constant motion. At 
times they are fissures, extensive, deep, bright red in color, and very pain- 
ful. These are produced by motion and strains upon the skin, which by 
its dryness is inclined to split readily. The affection is extremely obsti- 
nate, and yields very slowly to treatment. The hands must be protected 
from all irritating influences, soaps should be prohibited, and as little 
water as possible used. Every night they should be anointed with a 
preparation of boracic acid and vaseline, a drachm of the former to an 
ounce of the latter. After this is thoroughly rubbed in, kid or rubber 
gloves should be worn until the following morning. The fissures some- 
times heal so slowly they will need stimulating by pencilling with the 
nitrate of silver. 

In summer, exces-ive sweating of the hands is so annoying, gloves 
cannot be worn, or, if put on, they are quickly ruined. For this condi- 
tion, treatment is advised in the section devoted to bathing. 

Very iew people know how to properly care for the nails. In cleaning 
them, a sharp knife ought never to be employed, but between the ends of 
the nails and the fingers, the space should be filled with soap, which should 
then be removed with the so-called nail-brush. Many improperly cut 

120 



CARE OF THE NAILS. 121 

away that part of the flesh which grows over the nail from the bottom ; it 
should simply be pressed backwards, and sufficiently away to show the 
white part, considered by some to be a mark of beauty. If the flesh is 
adherent to the nail, the operation may be facilitated by passing the sharp 
point of a knife underneath the fold of flesh and separating it from its 
attachments. When this is done, it can be pushed back more readily. 

Scissors should never be used to cut the nails; that should only be 
done with a sharp pen-knife. Some persons are extremely fastidious in 
the care of their nails, considering their toilet incomplete unless they are 
polished with the pad provided in nail-sets for that purpose. 

A very common and troublesome affection is that which is popularly 
termed "the ingrowth of the nails," and which most usually occurs by 
the side of the great toe. There is really no alteration in the nail, as its 
name would imply ; the adjoining soft parts are first swelled and inflamed 
by constant pressure against the edge of the nail from the use of tight 
shoes. 

If this state is permitted to continue, an ulcer is formed in which the 
edge of the nail is imbedded. Pain is the consequence, sufficiently severe 
in some instances to prevent walking. Treatment for this condition often 
demands the skill of a physician. The sufferer might attempt a cure by 
the simpler methods, and, if they fail, professional assistance should be 
sought. The first object is to remove the cause, then to lessen the irrita- 
tion and reduce the swelling. After soaking in hot water, the nail should 
be thinned by scraping, and, if very painful, a flaxseed poultice will bring 
relief. After the irritation has sufficiently subsided, soft cotton should be 
pressed between the flesh and the nail, and, after that is done, it should be 
saturated with the tincture of iodine, and the application repeated several 
days, after which the tenderness will disappear. It may be necessary to 
lift the end of the nail, and this can be done by pressing cotton between 
it and the toe. This treatment is usually effectual, and is attended with 
as little pain as any which can be suggested. 

In the earlier stage of the affection, when some tenderness exists, but 
not sufficient to render more radical treatment necessary, the phenol- 
camphor can be used with good results. If the druggist consulted is 
not familiar with the preparation, he can easily compound it. Phenol- 
camphor is best obtained by heating crystallized carbolic acid until it 
melts, and then gradually adding camphor; a clear liquid is obtained. To 
use this remedy for the ingrowing of the toe-nails, it is necessary to push 
back the flesh from the side of the nail, and paint the crevice with a 
camel's-hair brush dipped in the fluid. This application not only controls 
all pain, but also has a curative influence, and if pressure from the toe is 
removed, in many cases no other treatment will be needed. 

To prevent the ingrowth of the nails, they should be trimmed squarely 
and straight across, and the angles left so long they will not be overlapped 



122 TAKE OF THE HANDS. 

by i he bordering folds of skin. The boot or shoe should be wide and 
roomy at the toes, to preclude lateral pressure. 

The structure of the nails may become hypertrophied, enlarging in 
various directions, as in length, width, and thickness. These changes may 
occur independently of diseases in other parts of the body, or may appear 
with general or constitutional disorders. Onychauxis is the term used to 
denote a simple increase in the normal growth of the nail. When the nail 
inclines to grow in a twisted, curved manner, in resemblance to the horn 
of a ram, the condition is called Onychogryphosis. 

Among the more common diseases affecting the ringers is the whitlow, 
or paronychia, of which there are several varieties. The most simple form 
is termed the cutaneous whitlow, and consists of inflammation of the surface 
of the skin, with burning pain and the formation of a blister rilled with a 
watery or bloody fluid. In another variety of whitlow the tissues beneath 
the skin are affected ; it much resembles a boil. It is attended with severe 
pain and throbbing; pus forms at the root of the nail, in some instances 
causing it to fall off. Poulticing is usually all these forms of whitlow 
demand in treatment. If fluid forms, the sufferer himself can generally 
evacuate it. 

The so-called felon is an acute inflammation of the sheaths of the 
tendons, or of the covering of the bone. It is accompanied with very 
severe throbbing pain, great tenderness, and often much constitutional 
disturbance, as indicated by fever and rapid pulse. This affection is not 
only very distressing, but is also attended with danger. In persons debil- 
itated and sickly, death has been known to result from poisonous absorp- 
tion. The skin covering the fingers is very thick, so also are the deeper 
coverings, especially that which envelopes the bone. When pus forms, it 
finds an opening upwards difficult, and therefore burrows back towards 
the hand. This course is easy if it forms in the sheath of a tendon, and 
not many hours need elapse before it reaches the palm of the hand. 

As the inflammation extends, the danger becomes intensified. The 
abscess, which but a few hours previous was confined to the finger, now 
involves the hand, and from there, if not cheeked, it proceeds up the 
wrist, then to the elbow, and even to the shoulder. In the meantime, the 
sufferings are terrible, the parts are enormously swollen, and the skin 
seems bursting. If a knife is not used to make free openings along the 
track of the disease, the pus will probably at last struggle to the skin and 
discharge itself, but before doing so the muscles will be broken down, 
honeycombed, and destroyed. The parts involved by the inflammation 
will be left stiff and useless for months, and if the affection has run a 
severe course, it is doubtful if they ever recover their original integrity. 
Partial death of the bones is not uncommon, and if the muscles have been 
seriously affected, they rarely if ever renew their loss, but waste, and at 
last the skin is tightly drawn over stiffened, motionless bones. 



FELONS AND WARTS. 1 23 

This pen-picture in outline is no exagger.it ion ; eases following the 
course described are by no means uncommon. While on duty in the 
hospital, the writer has seen more than one unfortunate admitted, who, 
to save his life, was obliged to suffer amputation of the hand. This mis- 
fortune has a terrible significance, when it is realized that a simple cut of 
the knife, while the disease was confined to the finger, would not only 
have ended pain, but also have averted the dire calamity. 

A felon is easily recognized; none are so ignorant that they cannot 
detect it in the early stage. While yet confined to the end of the finger, 
if it appears there, the sufferer, without waiting to test the efficacy of his 
neighbors' whims, and the virtues of elderly ladies' "sure cures," should at 
once place himself in the care of a physician. If he is competent, the fact 
will be readily apparent, for he will, even before there is much swelling, 
insist upon opening the abscess without delay. If the physician urges 
this treatment, and the patient through fear of the knife declines, then the 
latter assumes all responsibility, and for whatever may happen subse- 
quently can blame no one but himself. If, on the other hand, the medical 
attendant does not insist upon making an opening to admit of a free dis- 
charge of pus which may have formed, or which there is reason to believe 
will form, then he is liable for any misfortune dependent on the burrowing 
of the pus, for he has clearly and unmistakably failed, through ignorance 
or neglect, to perform his duty to his patient. 

Warts on the hands are a source of annoyance to many, and the 
causes which give rise to them are obscure. The various influences which 
are popularly assigned as causes are incapable of producing the growths. 
The remedies which have been advised are numberless; some of them are 
mere ancient absurdities. The use of caustics should not be attempted by 
the unskilled. 

Two new prescriptions for the treatment of warts are announced in 
the Wiener Med. Blatter. One is the application of a piece of lemon-peel 
which has been immersed for eight days in acetic acid three or four times 
renewed. The slice of peel is left on the wart until it dries, which it does 
in about nine hours, and this is repeated four or five times. The wart is 
then so much loosened that it can be removed by strangulation. The 
second mode of treatment is to insert a pin beneath the wart, avoiding 
the healthy skin, and then to heat the pin's head in a spirit-lamp. This 
causes the wart to become white and shrivelled at once, when it is easily 
removed without any bleeding. 



CHAPTER X. 

CARE OP THE FEET. 

From the fact that abuse of them is so common, it is evident that too 
many fail to recognize the importance of properly caring for the feet. 
Vanity, fashion, neglect, and ignorance have all been pernicious agents, too 
powerful for reform to subdue. The foot is a structure of wondrous 
strength and delicacy. The mechanism is a marvel of ingenuity, with 
which nothing contrived by man can compare. It easily supports great 
weights, is susceptible of many movements, and sustains shocks without 
injury. It is an arch of bones, united by cartilages, bound by ligaments, 
and controlled by tendons. It is perfectly adjusted and complete, with no 
deficiency or excess ; the foot, from the hands of Nature, is simply per- 
fection. 

That the coverings of the feet should be in exact conformity needs no 
proof. Nature has designed the toes to be as movable as the lingers; this 
fact can be readily believed by those who have noted the adroitness of 
cripples born without hands. It is obvious that the soles of shoes should 
be sufficiently broad to allow every toe to act unconfinedly. The long 
shoe, narrower than the foot, either holds the toes firmly pressed together, 
or forces them over one another, in which position they are comparatively 
useless. The broad, but too short, boot causes the toes to turn under, and 
they thus become unserviceable. Nature, reason, and experience should 
discard the fashions which demand either abuse. 

The heels of shoes have ever seemed a source of discontentment. 
From high to low, from large to small, now placed at the rear, again 
near the middle, the transitions of the mode are indescribable. Properly, 
the heel of the foot should be no higher than the sole; such was evidently 
the intention when man was created. Custom has somewhat modified this; 
and sensibly constructed heels, if not a necessity, at least add to the com- 
fort. The shoes of "long-distance" pedestrians are made with the barest 
approach to a heel. The lesson taught by these athletes is a valuable one, 
and should be appreciated. Some authors have placed the limit of height 
at three-fourths of an inch ; greater restriction would be justifiable. Heels 
should be broad and as low as comfort will permit. If placed too far 

124 



EVILS OF TIGHT-FITTING SHOES. 12;") 

forward, the clastic action of the foot is interfered with; if too small, the 
ankles arc weakened and easily sprained. Falls down stairs have been of 
sufficient frequency to convince women that high-heeled slippers are a 
source of clanger. 

But few people will err on the side of judgment, and wear shoes too 
large for their feet. Such a habit has its disadvantages, and results in 
blisters and callosities. To preserve the natural form of the foot, the shoe 
must be rightly shaped and properly fitted, and when first worn should be 
sufficiently easy to render the abominable and painful "breaking-in" 
process unnecessary. If this advice is followed, corns and bunions will 
never appear, and other painful consequences of abuse will be escaped. If 
Nature is outraged, the violator will convert his feet into so many barome- 
ters, to indicate the present and foretell the future changes in the weather. 
For him walking will be difficult and fatigue easy. His knees will stiffen, 
and his movements become awkward. Enlarged and painful joints will 
partially cripple, cold feet will testify to changed circulation, and finally 
general disorders will be added to the penalty. On the other hand, he 
wdio will be governed by common sense and a proper observance of physi- 
cal laws, will find greater comfort, enjoy better health, and multiply the 
chances of long life. 

The proper material for shoes is that which is sufficiently compact to 
prevent water from penetrating it ; so soft and elastic it will admit of an 
easy and unrestrained motion of the whole foot. Too thick soles are 
objectionable, being fatiguing by reason of weight and inflexibility. 

The best form of covering for the foot is the laced shoe; the elastic 
gaiters almost always fit too tightly about the ankles, and prevent needed 
ventilation. High boots have decided disadvantages, and generally allow 
the heel to slip in walking, unless the foot be too firmly held at the instep. 
Almost all who have been measured for shoes have learned that there is a 
difference in the size of their feet. For this reason the "ready-made" 
will rarely fit properly. If the heels of shoes are broad and low, they will 
generally wear evenly ; if they do not, they should at once be straightened. 
The defect is usually in the shape of the shoe; that the maker can easily 
determine. 

Some will find it a source of comfort if two pairs of shoes are in use, 
and each worn on alternate days. For those who are annoyed by excessive 
perspiration of the feet this custom has especial advantages, as the linings 
rarely become thoroughly dried in one night, and, if not, they soon acquire 
an exceedingly offensive odor. 

The subject of stockings is one of infinite importance ; women even 
more than men need to show good judgment in their selection. Some of 
the fashions of the former could be in safety followed only by the High- 
landers, inured to the cold from childhood. By their extremely open 
texture many stockings are no protection whatever. As has been stated 



126 CAKE OF THE FEET. 

elsewhere, cotton alone is but little defence against cold, and is therefore 
insufficient for clothing. As a shield against exposure in winter, both 
cotton and woollen should cover the feet and limbs below the knees. 
Since a trifle larger boot must necessarily be worn, it is obvious that 
but few will follow this advice, and some concession must be made. 
If. however, women in this instance ignore the promptings of vanity, 
the comfort and better health enjoyed will more than compensate. Cold 
foot will be unknown, and many irregularities evaded. Those who insist 
upon wearing cotton stockings alone inside their boots must without fail 
in cold weather employ woollen leggings and overshoes when in the open 
air. 

As a general rule, for men who are very active, woollen stockings are 
the most comfortable. When free perspiration of the feet is annoying, 
relief is secured by the habit of wearing them continually, through summer 
and winter. As a protection against cold, both cotton and wool are the 
surest. 

A radical treatment for excessive perspiration of the feet, accompanied 
by offensive odor, is to discard all shoes previously worn ; then, with thin 
Scotch wool stockings, low shoes should be procured, and the ankles pro- 
tected with cloth gaiters. Every night, after bathing the feet with cold 
water, powdered starch or magnesia should be rubbed well into them, and 
it is well to sleep in thin socks, in which either of these powders has been 
sifted. It may be necessary, also, to sift one of these powders into the 
stockings worn during the day. 

Occasionally, from excessive perspiration of the feet, the toes become 
painful from the process of maceration. The treatment for this disturbance 
is to apply "black-wash" on thin cloths between the toes, for five minutes 
morning and night. During the day, thin cloths spread with diachylon 
ointment should be worn between them, to prevent chafing and promote 
healing. 

The overshoes commonly called "rubbers" maybe worn in wet weather 
during the warmer months, but for the colder the combination cloth and 
rubber, denominated the "Arctic," are alone serviceable. These, as with 
heavy underclothing, should not be laid aside until late in the spring, when 
once they are assumed. There are clays in winter when the temptation to 
dispense with them is great, but the danger of so doing is considerable, 
chills and colds being often the consequences. The leather shoes worn 
with the overshoes should be thin and loosely fitting; an old pair needing 
patches is the better, ventilation being secured. Some men still suffer 
from cold feet, notwitstanding they wear cotton and woollen stockings, as 
well as overshoes. Xearly all of them are annoyed by excessive perspira- 
tion, which a thick boot is instrumental in promoting. They can remedy 
this evil by wearing, instead of leather, a cloth gaiter, similar to those 
which elderly ladies luxuriate in. 



NECESSITY OF KEEPING THE FEET WARM. 127 

An .abbreviation of one of the ancient laws of health is "head cool and 
feet warm." An observance of this is one of the primary essentials to 
good health. Indigestion is invited by a hearty meal eaten when the feel 
are chilled. The old-fashioned warming-pans have been ridiculed into 
obscurity. In their use there were some advantages at least; no one 
needed to suffer from sleeplessness caused by cold feet. The value of cold 
foot-baths and friction must not be forgotten, and for those in whom circu- 
lation is deficient a hot brick or flat-iron, wrapped in flannel, is often 
essential, and should always be employed to restore warmth to their feet 
after retiring. 



BOOK SECOND. 



MENTAL HYGIENE. 



INTELLECTUAL OPERATIONS. 

Ax exhaustive treatise on the subject of mental hygiene is beyond the 
province of this work, and the sc iss >n is necessarily limited to a few of 
the most important considerations. A study of the mutual relationship 

sting between the mind and body is of infinite importance in the educa- 
tion of self to a proper Knowledge of Nature's laws, and their correct 
interpretation. It is apparent to all that if the functions of either are dis- 
turbed or disordered, the sympathy of the other is at once manifested by 
an interruption of its appropriate acti 

Among the essential characteristics which distinguish man from animals 
is his higher measure of intellectual endowment, mental capacity, limitless 
unprovability, and the possession of moral sentiments. Instinct, the in- 
heritance of all living things, has been defined as peculiar inward feelings 
or sensations, originating urgent wants or desires, which stimulate or call 
forth certain muscular actions, the purj >se . end of which is. by satisfy- 
ing the want, to relieve the sensation which excites it. The serie- : 
physical actions produced by the promptings of simple undiscerning 
instinct take place independently of education or imitation, and without 
any foresight of the end to be attained by them. The appetites hunger 
and thirst are the most ready illustrations of this phenomenon. 

As the reasoning powers of man become developed, they in a great 
measure control instinctive propensities. When his mind expands and his 
intellectual faculties attain a higher -rate of advancement, this mere animal 
prompting becomes less active and dominant. Thus by mental progress is 
man exalted, raised, as it were, out of the pale of the animal kingdom. It 
is through a high and proper cultivation of the intellectual that not only 
the moral but the physical nature is elevated and improved. As the higher 
faculties of mind are developed, a more just appreciation of obligations is 
acquired, and this knowledge promotes a more perfect state of morals, and 
contributes immeasurably to the protection of bodily health from harmful 
influences and excet 

128 



A WISE DISPENSATION. 129 

All the bodily and mental functions are so closely united by sympathies, 
the improvement of each one contributes, to a greater or less degree, to a 
healthful influence on every other. As a man grows in wisdom lie is 
happier, and judicious exercise of the body conduces to mental strength 
and energy. The decree to labor was a wise dispensation, as absolutely 
necessary both to the moral and physical well-being of mankind. It has 
been said: "The feeling that life is without aim or purpose — that it is 
destitute of any motive to action — is of all others the most depressing, 
the most insupportable to a moral and intellectual being. Man, at the tm]^ 
is very apt to lament that existence has been a failure, because he has not 
reached some point — attained some eminent good — at which he could 
sit down content and happy, and to which all his hopes and labors had 
been directed. But we should know T — and the earlier we know this the 
better — that life is a chase, and a chase after something which we never 
overtake. And is it not the chase, more than the possession of the game, 
that brings joy and animation to the huntsman ? Let us, then, enjoy the 
chase, and be satisfied when it is finished, though the game has continued 
to elude our pursuit." 

It is essential to perfect bodily health and mental soundness that none 
of the functions are habitually overtasked. As intemperate muscular 
exertion is punished by bodily weakness, so are the energies of the brain 
impaired by immoderate intellectual effort. The capabilities of the mind 
should be carefully studied, and its labors restricted within the limits of 
moderation, or loss of power will inevitably result. For those whose 
efforts are largely confined to the employment of the intellectual faculties, 
temperance, both in eating and drinking, is one of the rules of health most 
important for them to observe. 

Persons of studious or sedentary habits neither require nor can they 
properly digest food of the same quality and quantity suitable for those 
whose occupations necessitate greater physical exertion, and in whom the 
bodily waste is necessarily greater. Over-indulgence at the table dulls 
understanding and lessens the activity of the mental faculties. Literary 
work which can be easily performed before becomes difficult and laborious 
after dinner. Those who are addicted to excesses in eating are, in the 
end, punished by impairment of intellect. They become sluggish of 
thought and slow of perception ; both memory and judgment are obviously 
weakened. 

The importance of sufficient daily exercise to the health of intellectual 
men cannot be exaggerated. The same may be said also of adequate 
and regular repose, as few causes are more potent in shattering the nervous 
energies, weakening the constitution, and hastening on the infirmities of 
old age, than deficient and irregular sleep. 

For those devoted to intellectual employment frequent relaxation and 
amusing recreation are imperative. The natural tendency of the student is 



INTELLECTUAL OPERAT. 

rod its innocent frivolities. Such a cours lorable, 

]>ervert the nature ami make one gloomy, irritable, and-mis- 
anthr 

can profitably devote to study more than seven hoi; . and 

the intellectual efforts should cease when the brain grows wear; $ its ipa- 
bilities diminish, and productions, iu consequence, are labored and feeble. 
It has been truly said that - there is scarcely any book which does not 
r of painful composition in some part of it, because the author has 
written when he should havv 

The operations of the mind are seldom, if ever, altogether isolated from 

x»n ; with them are necessarily associated, to a greater or less extent, 
such emotions as joy, hope. fear. envy, jealousy, and auger. That those 
influences are potent agencies in producing physical infirmities, and inducing 
premature decay, there is reason to believe. It has been said that it is not 
always to the midnight lamp alone, as is commonly supposed, that the pale 
cheek and contracted brow of the scholar are due. The ambitious striir. s 
active among literary men, and the anxious desire for success and popular 
favor, and all the consequent moral agitation and suffering from envy, 
jealousy, anxiety, deferred and defeated hopes, oftentimes do more, far 
more, to break down the constitution than would even the most arduous 
mental efforts in their unblended operation. 

Dr. Pin" sajs: 7 is well known that certain professions conduce 
more than others to insanity ; they are chiefly those in which the imagina- 
tion is unceasingly or ardently engaged." On consulting the registers of 
Bieetre, he found many priests and monks, as well as country people, had 
been terrified into insanity by the anticipation of the torments of hell; 
also instances where actors, painters, sculptors, musicians, and poets had 
been transported into madness by their own productions. Nc : 

insanity were furnished by those professions requiring the habiturt" 
of the judging faculty ; none from among naturalists, physicians, ehem 
or geometricians. 

Since of all mental avocations the intellectual labors in which the deep 
and fervent passions are more frequently awakened are most detrimental 
to health, those devoted to them should be swayed by reason, the proper 
controlling power of all subordinate faculties. They should appreciate the 
dangers which they incur, labor only within the limit of moderation, and, 
proper observance of Nature's laws, cherish and save from decay the 
which she generously bestowed upon them. 

remind is continuously concentrated upon an especial subject 
soon becomes fatigued and weakened, as the muscles are tired and exhau 

ne prolonged physical effort. Change is essential alike to health and 
happiness. The intellectual labors should be diversified, and the po 
refreshed and renewed by relaxation, indulgence in amusing recreation, and 
habitual muscular exertion. 



PASSIONS FOUNDED ON PLEASURE. 131 

It is proper here to remark that the mind should become matured with 
the body, and inordinate exercise of the intellect must be restrained, or the 
most grievous consequences are almost certain to follow. As Rousseau 
says: "Nature intended that children should be children before they are 
men; and if we attempt to pervert this order we shall produce early fruit 
which will have neither maturity nor savor, and which soon spoils: we 
shall have young learned men, and old children. Infancy has an order of 
seeing, thinking, and feeling which is proper to it. Nothing is more fool- 
ish than to wish to make children substitute ours for theirs; and I would 
as soon require a child to be five feet high as to require judgment at ten 
years of age." 

Passion has been not inaptly defined as any emotion of the soul which 
affects the body and is affected by it. Such is the sympathy existing 
between the mind and the body, the moral feelings exercise a potent influ- 
ence on the physical organs, while the latter in turn affect the former. 
The effect of mental emotions is manifested in the vital functions, and 
certain states of these functions serve in a like manner to awaken the dif- 
ferent passions. 

The passions founded on pleasure seem to act as a universal stimulant 
to all vital action. Circulation is quickened, the blood distends the vessels 
of its system, the face brightens, the skin assumes a ruddy tint, the muscles 
grow stronger and invite activity. The whole body is re-animated — in 
short, every function responds to the vitalizing influence of the happy moral 
condition. As Haller says: "Love, hope, and joy promote perspiration, 
quicken the pulse, promote circulation, increase the appetite, and facilitate 
the cure of diseases." 

While joy and kindred emotions thus contribute to health, by inducing 
a more active performance of all the vital functions, as with all other stimu- 
lants, the pleasurable feelings become painful if the bounds of moderation 
are exceeded. As one author says: "Extravagant and unexpected joy 
unduly excites the nervous system, increases unnaturally and unequally the 
circulation, and occasions a painful stricture of the heart and lungs, accom- 
panied by sighing, sobbing, and panting, as in severe grief. Under its 
influence too the visage will often turn pale, the limbs tremble and 
refuse their support to the body, and, in extreme cases, fainting, con- 
vulsions, hysterics, madness, temporary ecstasy or catalepsy, and even 
instant death, may ensue. If the subject be of a delicate and sensitive 
constitution, and, more especially, if he labors under any complaint of the 
heart, the consequences of the shock to the nervous system of sudden and 
immoderate joy will always be attended with hazard." 

While the emotions to which pleasure gives birth equalize the circula- 
tion, direct the blood to the surface, as it were expand the body, lighten 
and cheer the heart, and give spirit and vigor to all the functions, those 
founded on pain induce a series of results precisely opposite in their 



132 [NTELLECTUAL OPERATIONS. 

character. Under the influence of the latter, the body seems to shrink or 
contract, the blood is driven to the internal organs, loading them to excess, 
and they in turn manifest their oppression by a painful sense of stricture 
and suffocation, and the consequent desire for fresh air, which always 
marks the intensity of this class of passions. The frequent sighing, under 
great affliction, is the natural effort to relieve the suffering organs, as, by a 
freer expansion of the chest, a larger supply of air enters the lungs. 

On the nervous system the effect of the painful passions is manifested 
by depression, derangement, and, possibly, destruction of the vital energies. 
The same agencies influence the various secretions, by increasing, dimin- 
ishing, or vitiating them. When the mind is severely and unpleasantly 
agitated, dryness of the mouth testifies to the suppression of the salivary 
secretion. This is proved "by the well known test, often resorted to in 
India, for the discovery of a thief amongst the servants of a family, — that 
of compelling all the parties to hold a certain quantity of rice in the mouth 
during a few minutes, the offender being generally distinguished by the 
comparative dryness of his mouthful." 

Under the influence of disturbing passions certain secretions become 
corrupted, and even acquire poisonous properties. It is a known fact that 
the bite of an animal goaded to desperation heals less rapidly and is 
attended with greater inflammation than one administered when the system 
is uninfluenced by the excited passion. Great mental disturbance in the 
mother diminishes or vitiates the secretion of her milk, and it becomes 
hurtful to the nursing child. 

The contrast between the physiological effects of the pleasurable and 
painful emotions, and their influence upon health, are obvious to all. In 
the faces of the happy and confident is seen the bright glow of natural 
vigor, while the drawn, careworn, and pallid features of the sad and 
despondent testify to inward suffering. 

The instinct of self-preservation is the parent of anger, and this passion 
is therefore an essential constituent of the natures of all living beings. 
As has been said : "It is aroused by and at the same time urges us by an 
instinctive impulse to repel or destroy all such causes as oppose or threaten 
our moral or physical ease and security ; or, in other words, which bring 
unhappiness to the mind, or pain, injury, or destruction to the body. 
Hence it is often directed against the irrational and even the inanimate 
objects of creation. Modified and abused, therefore, as we find it, it was 
originally implanted in our breasts as a safeguard alike to our happiness 
and existence." ■ 

The extreme paroxysms of anger induce the most distressing physio- 
logical manifestations. All the vital functions are at once heavily 
oppressed, or suspend their actions; the heart becomes labored, feeble, 
and irregular in its movements; the surface of the body, deprived of its 
blood, is blanched; the breathing is short, difficult, and spasmodic, and the 



ANGER AND FEAR. 133 

power of speech is interrupted. The muscular system is deprived of its 
power, and its movements are for a time beyond control. Reason is 
dethroned, and the mental faculties are no longer subservient. 

Unless re-action comes to the convulsed and stricken system, life goes 
out. The instances of sudden death from anger's shock have been many. 
Re-action, however, commonly ensues; it comes speedily, and often com- 
mences with the beginning of the paroxysm. As the functions recover 
from the shock, excitement displaces inaction; the heart is aroused; with 
quick pulsations and great force, it sends the blood hurrying to the brain 
and surface, and soon the vessels of those pails become swollen and dis- 
tended. The brain becomes heated, the face flushed, the eyes reddened 
and blazing; to the muscles comes an unnatural strength; the hands invol- 
untarily close and the teeth are clenched, as though in preparation for the 
encounter. Instinct then reigns; will and reason are subordinated. In 
this re-active stage, to which the names fury and rage are applied, mental 
balance is lost, perceptions are blunted, and judgment yields; this condi- 
tion of mind is akin to insanity. Fear is sometimes associated with 
anger, and its influence renders the passion still more depressing. When 
the two are mingled, the pallor of the surface is due to the apprehension 
of injury. 

In diseases of the heart, anger is a potent agency of evil. If death 
does not occur from a sudden, intense shock, the organ is enfeebled by 
every fit of passion. In persons of a plethoric habit and given to excesses 
in eating, and in those in whom the coats of the blood-vessels of the brain 
have been weakened by degenerative changes, anger increases the danger 
of apoplexy. A variety of other diseases is liable to follow immoderate 
anger; among them maybe mentioned paralysis, epilepsy, and hysteria. 
Anger, or violent or ungovernable temper, as it is sometimes expressed, 
holds, according to the reports of the different lunatic asylums both in 
Europe and America, a prominent place among the causes of insanity. 

In habitual irritability or fretfulness of temper, hatred, revenge, envy, 
and jealousy, and in fact in all dispositions of the mind characterized by 
bitter feelings towards others, a measure of anger is almost necessarily 
blended. The effect which the mind, harassed by passions of this nature, 
has upon the bodily health is to propagate derangements and infirmities. 
The appetite lessens, digestion is impaired, and then follow other functional 
disorders. The nervous system suffers from continued mental irritability, 
and hysteria, headache, and other painful affections often owe their origin 
to this prejudicial influence. Physicians well know that when the system 
is laboring under disease, a temper amiable and tranquil under the little 
ills and crosses of life encourages recovery, while one easily inflamed by 
the baser passions obstructs it. 

As has been aptly said : " An irritable and fractious temper, whether 
due to an active temperament or other causes, becomes, necessarily, the 



134 INTELLECTUAL OPERATIONS. 

instrument of its own punishment. And it furthermore poisons the hap- 
piness of all within the circle of its influence. To so many occasions of 
annoyance, to so many potty vexations, are we all, even the most fortunate 
of us. exposed, that the happiness of the naturally irritable man must be 
continually encountering obstacles, and his health consequently be ever 
liable to injury. Heavy indeed are the penalties to which we are often- 
times doomed for the native faults of our organization !" 

While the malevolent feelings with which anger is blended are the 
promptings of an ill-conditioned mind or uncontrolled temper aroused by 
external influences, they may be excited by unhealthy states of the organs, 
and thus originate within the body. In certain functional disturbances and 
diseased conditions, the mind sometimes becomes disturbed, and the dispo- 
sition peevish and irritable. Persons naturally amiable and patient under 
outward annoyances will often become anxious and fretful when attacked 
with bodily infirmities. Disturbances of the stomach;, liver, or other 
important organs are thus active in perverting reason, and in rendering the 
disposition suspicious, peevish, and morose. 

Fear, like anger, being founded on self-preservation, is, by force of 
instinct, essential to all animals. This passion commonly bears a distinct 
relation to the feebleness and defencelessness of the individual, as a sense 
of weakness begets timidity, while a knowledge of strength imparts bold- 
ness. This conformity cannot be said to exist excepting in such states of 
danger as demand force of resistance or strength of physical action, "for," 
as has been said, " under real calamities, and sufferings when endurance 
alone is required, woman will oftentimes display a degree of firmness of 
which our own stronger sex might well be proud. Woman looks to the 
strong arm and bold spirit of man for protection and defence, while he 
turns to her more delicate and passive nature for consolation and support 
under those ills of life against which his courage is powerless and his 
strength vain." 

The condition of the system influences the susceptibility to fear. As 
a general rule, good health conduces to boldness, while disordered states 
depress courage, and transform the daring into cowards. In severe 
derangements of the stomach and liver, mental depression and an appre- 
hension of evil are prominent symptoms. While courage generally attends 
health and physical vigor, instances are not wanting where the most daring 
natures exist in frail, weakly bodies. Some of the bravest men who have 
faced dangers, and have borne suffering before which those of great 
physical strength quailed, have been the most delicate and effeminate 
in body. 

Fear is one of the most painful passions, and its influence is powerfully 
felt both on the mental and bodily functions. It is manifested in various 
degrees, and may be slight and transient, or of an intensity sufficient to 
dethrone reason, ruin health, or even cause the death of the person affected. 



CONSEQUENCES OF EXCESSIVE FRIGHT. 135 

Fear, in its most exaggerated degree, induces physiological symptoms 
much resembling those excited by anger in its greatest intensity. Other 
physical manifestations are present when the system is influenced by terror, 
and among them may be mentioned glaring of the eyes, trembling of the 
limbs, chattering of the teeth, and the cold, dewy sweat which sometimes 
pours out over the surface, and especially about the forehead. The 
countenance is drawn into a most distressing and repulsive expression, 
the whole muscular system is often strongly convulsed, its energies 
temporarily suspended, and the person affected rendered speechless and 
motionless. 

But few of the painful passions long maintain their simple and original 
character, and thus it is that fear is often blended with anger, which, when 
it is manifested, constitutes re-action, and counteracts the threatened con- 
sequences of the primary systemic shock. Many of the noblest heroes, 
recounts of whose daring deeds on the battle-fields fill pages of history, tell 
of the terror which they felt when they received their " baptism of fire " 
from the guns of the enemy. 

Under certain circumstances and in certain constitutions, terror has a 
paralyzing effect upon those muscles which are under the control of the 
will. This influence which causes abolition of power is called fascination, 
and is possessed in a marked degree by some species of serpents, which 
exert it on birds and other living things upon which they prey. An 
effect quite the reverse sometimes results from extreme terror; instances 
are not wanting where, under its influence, persons long deprived of 
nerve-power in certain muscles have had it restored by the influence of 
a sudden shock. 

Death is sometimes the consequence of excessive fright, and the influ- 
ence of fear upon imagination is well known. Lord Littleton is said to 
have died at the exact moment at which he fancied vision had fore- 
warned him his death would take place, and many other cases are recorded 
where terror has caused like dire results in superstitious subjects. 

Derangements both of the mental and physical organization are often 
induced by fear, and not unfrequently they are serious and lasting; this is 
especially the case of young children. One instance will serve as an illus- 
tration : "A schoolmistress, for some trifling offence, most foolishly put a 
child into a dark cellar for an hour. The child was greatly terrified, and 
cried bitterly. Upon returning to her parents in the evening she burst 
into tears, and begged that she might not be put into the cellar; the 
parents thought this extremely odd, and assured her that there was no 
danger of their being guilty of so great an act of cruelty ; but it was dif- 
ficult to pacify her, and when put to bed she passed a restless night. On 
the following day she had fever, during which she frequently exclaimed, 
' Do not put me in the cellar ! ' The fourth day after, she was taken to 
Sir A. Cooper, in a high state of fever, with delirium, frequently mutter- 



136 INTELLECTUAL OPERATIONS. 

ing, 'Pray, don't put me in the collar!' When Sir Astley inquired the 
reason, he found that the parents had learned the punishment to which she 
had been subjected, lie ordered what was likely to relieve her, but she 
died in a week after this unfeeling punishment." 

As lias been said: "Religion, when perverted from its true purpose of 
hope and consolation, and employed as an instrument of terror, when, 
instead of being gentle, peaceful, and full of love, it assumes a gloomy, 
austere, and threatening tone, may become productive of a train of nervous 
complaints of the most melancholy and even dangerous nature. The 
austere bigot, who owns a God of terror and vengeance, becomes a slave of 
the direst passions. All who differ from his creed are to be hated as the 
enemies of Heaven and the outcasts of its mercy; and he may even persuade 
himself that to inflict upon them bodily tortures is an acceptable religious 
duty. This spirit of gloomy fanaticism has been one of the severest 
scourges of our species. No human sympathy has been able to withstand 
its merciless pow r er. It has set the parent against the child, and the child 
against the parent, and has blasted every tie of domestic affection. There 
is, perhaps, no enthusiastic infatuation which has been more harmful, both 
to mind and body, than that of religion. The relentless and fearful pas- 
sions awakenened by a gloomy and vindictive religion, fraught with unim- 
aginable future terrors, have been productive, alike in past and recent 
times, of the most melancholy disorders, both in the moral and physical 
constitution." 

The revivalists or religious enthusiasts, who seek to make converts by 
inciting the fears rather than by inducing belief with a calm, unimpassioned 
series of reasoning, are potent agents in causing nervous affections, by 
arousing superstitious terrors in their sensitive and sympathetic listeners. 
All those who have attended the so-called "camp-meeting" must have 
witnessed the frightful effects induced by intemperate oratory, prompted 
by perverse and mistaken zeal. Dr. Prichard, in referring to several cases 
of insanity caused by religious anxiety, says: "Some of these have 
occurred among persons who had frequented churches or chapels where 
the ministers were remarkable for a severe, impassioned, and almost impre- 
catory style of preaching, and for enforcing the terrors rather than 
setting forth the hopes and consolations which belong to the Christian 
religion." 

The serious consequences which have been known to follow excessive 
fright are almost numberless, and afford ample testimony of its evil influ- 
ences upon health. Few causes will more certainly impair the intellect, 
shatter the nervous system, and break down manly strength, vigor, and 
other eminent qualifications than the habitual indulgence in imaginary 
fears. 

When the system is prostrated by disease, fear is a depressing agency 
which, in a measure, obstructs recovery. It is a known fact that a strong 



GRIEF AND DESPONDENCY. 137 

will and a hopeful spirit arc powerful influences which stimulate the 
re-active and restorative powers of the vital economy. Fearlessness and 
self-reliance are alike important to both moral and physical well-being, at 
all periods and in all conditions of life. A bold and undaunted spirit may 
justly be considered as an essential attribute of health in its highest stale 
of perfection. 

Grief is defined as pain of the mind produced by loss, misfortune, 
injury, or evils of any kind. It presents itself in various degrees, and 
may be light and transient, or a silent, deep, and painful affection, inspired 
by dire calamity. As differently modified, it is recognized as sorrow, sad- 
ness, affliction, melancholy, dejection, etc. 

This passion may be excited by the distress either of the body or mind 
experienced by near and dear friends, or it may be united with other pain- 
ful passions, and is often blended with malevolent feelings, such as envy, 
jealousy, hatred, and revenge. As has been aptly said: "It is a law of 
our constitution that every good and benevolent affection should bring 
with it its own recompense, so likewise it is that every evil one should 
become the author of its own punishment. 'To love is to enjoy; to hate 
is to suffer.' In hating we punish ourselves, not the object of our hate. 
Self-interest, therefore, if we are actuated by no better, should be a suffi- 
cient motive for us to cultivate the amiable and to suppress the vicious 
feelings of our nature." 

The physiological manifestations induced by a paroxysm of grief 
much resemble those observed in subjects influenced by other painful 
passions. Upon the heart deep grief has a most oppressive influence ; it is 
racked with pain, and every pulsation of that organ is attended with a 
distinct, distressing thrill. The blood bounds violently in its vessels, and 
a general throbbing is felt throughout the whole body. Sorrow rests 
lightly upon some, but presses heavily upon others; the former, by a 
recital of their afflictions, court consolation, while the latter avoid all allu- 
sions to its source, shun even the consolations of friendship, and undergo 
far weightier suffering. The most poignant grief seems to benumb all the 
actions of life, and completely overpower the nervous energies; a person 
under its influence is silent, motionless, and stupefied. 

"The soul, by giving vent to sighs and tears, seems to disentangle itself 
and obtain more room for freedom," and thus it is that with the flow of 
tears comes re-action from the sharp inward torture of profound grief, 
and relief from its dread consequences. Persons who cannot weep under 
their afflictions generally experience far keener suffering than those in whom 
the outflow from the eyes responds readily to the influence of distress. 

Many cases have been recorded where instant or speedy death has fol- 
lowed the sudden shock of grief in its most exaggerated form. By its 
paralyzing influence in rare instances all vital functions are so completely 
overwhelmed, re-action does not take place, and immediate death results. 



188 [NTELLECTUAL OPERATIONS. 

Thus may grief be speedily destructive to health and life, but far more 
often its fatal influence is delayed, until, under deep moral suffering, the 

physical organization finally yields, and is shattered and broken. 

The baneful effects of deep and settled despondency on all constitutions 
cannot be overestimated. It may cause a total wreck of all the powers of 
the mind, leaving the unfortunate subject hopelessly insane, or, by its cor- 
roding influence, organic disease may declare itself, and thus, indirectly, 
the work of destruction be accomplished. Instances are not wanting 
where the first symptoms of disease of the heart could be clearly traced to 
sudden shock, induced by the tidings of a painful calamity. 

All authors agree that there is scarcely a function of the body which 
escapes the injury done by the influence of great dejection of spirits. 
That long-continued grief and anxiety of mind hasten the development of 
other diseases can readily be believed, and when those affections are once 
manifested their progress is more rapid when urged on by the depressing 
influence of this harassing passion. 

All observing physicians are fully conversant with the fact that mental 
afflictions are potent agents in retarding the restorative processes in all 
diseases and injuries of the body. In fact, when sorrow becomes settled 
and fixed in the nature, the whole vital economy soon languishes under its 
baneful influence ; circulation is enfeebled, nutrition is impaired, the skin 
grows pale and contracted, the eye loses its fire and becomes lustreless, 
lines form about the face and deepen as the burden grows heavier, the hair 
whitens under the oppression raid shares in the changes which mark an 
early and premature decay. 

The mind knows no rest; tortured in the waking hours by remem- 
brances of the past, defeated ambition, and blasted hopes, it moans over 
the tomb of fond expectations, buried beneath the weight of bitterness and 
disappointment. Sleep comes reluctantly, and no longer does it restore the 
system and re-animate its powers, for, broken and disturbed by terrifying 
dreams, the couch is one of misery, and even the paltry few hours' oblivion 
is denied. 

The nervous system is at last shattered by the depressing influences of 
prolonged mental sufferings; as has been aptly said, the soul and body 
wearing upon each other, the energies of both at last sink into irretrievable 
decay, and finally death mercifully comes and lets loose the troubled spirit. 

Despair is the extremity of moral depression, a hopeless state of the 
mind, when its powers are crushed beyond re-action and life has lost 
its every charm. It is to this hopeless and consummate misery that suicide 
often owes its origin. After long and fearful inward struggles against 
this reasonless impulse, the unnatural deed is at last consummated. 

Envy and jealousy are passions closely allied in their natures, and, as 
is true of all malignant feelings, both moral and physical suffering is the 
penalty of their existence. Locked within the breasts of those harassed 






ENVY AND JEALOUSY. 139 

by the degrading influences, they, when long and deeply indulged, prey 
alike on health and happiness, not only destroying the delights of life, but 
also engendering bodily derangements and infirmities. J)r. Zimmerman 
observes that there are many persons in the world who really owe their 
diseases to the passion of envy, and which diseases are the more dangerous 
from their cause being very often unknown. The silent, melancholy air 
we so often see in our patients, and the uneasiness and distress that do so 
much harm in diseases, very often arise from no other cause than a secret 
envy, which preys upon the heart and disturbs all the operations both of 
mind and body. 

Shame consists in wounded pride or self-love, and manifests itself in 
every degree, from the passing blush it brings to the cheek, to the deep and 
terrible consciousness of degradation which prostrates all the energies of 
mind and body, and renders life a burden. "Under an aggravated sense 
of humiliation, the mind experiences unutterable anguish, and the body 
cannot long remain unharmed. Insanity, convulsions, and even sudden 
death, may be the melancholy result of such painful moral condition. What 
feeling can be imagined more overwhelming to the proud and lofty spirit 
than that of deeply mortified self-love? Under its oppressive influence, 
existence itself is felt to be a cruel burden. In a state of society where 
mankind is necessarily exposed to so many and, oftentimes, severe mortifi- 
cations, and subject to such frequent and painful vicissitudes of fortune, 
the suffering and disease emanating from wounded pride can scarce be 
adequately estimated." 

This brief discussion has thus far been confined to those passions which 
are distinctive, and based either on pleasurable or painful emotions. There 
remain to be mentioned the so-called mixed passions, in which both happy 
and unhappy influences are active on the mind. 

Sexual jealousy, so termed, is founded on the pleasurable emotions of 
love, and with it those contending passions, hope, fear, suspicion, and anger, 
are often blended. The miser, possessed by avarice, finds pleasure in accu- 
mulating riches, but becomes misanthropic, gloomy, and apprehensive for 
the safety of his treasure. Thus fear, suspicion, and anxiety are mingled 
with the pleasurable feelings arising from the contemplation of his hoard- 
ings. Ambition, that aspiration so characteristic of mankind, based on 
pride and self-love, is always tinctured with the painful emotions, jealousy 
and envy, excited by rivalry and competition. 

Thus, in all conditions and stations in life, is man under the influence of 
passions which must contribute to his happiness or mar his mental and 
physical well-being. Strong impressions on the mind will ever reflect their 
influence upon the vital functions, and strengthen or prostrate their ener- 
gies. They will either promote physical, moral, and intellectual force, and 
perfection of human character, or corrupt the fountains of health and the 
sources of enjoyment. 



140 INTELLECTUAL OPERATIONS. 

That :i just appreciation of the moral influences upon health is essential 
to its preservation is clearly evident. The happiness of life is measured 
by the integrity of the vital functions, and so closely united are the mind 
and body, impairment of either inevitably induces disorder of the other. 
As the intellectual and moral powers become developed, they acquire a 
greater influence over the matured organization and its functions. So, 
also, a judicious physical education contributes to happiness, as under its 
influence even a feeble constitution, and the moral infirmities which are its 
almost necessary concomitants, may be in a very considerable measure cor- 
rected. It becomes, then, the duty of all to educate themselves to meet 
with tranquillity the ills and crosses of life which they must inevitably 
encounter. Although the passions given to man occasion so large a pro- 
portion of the ills which he is decreed to suffer, yet, when properly 
disciplined and brought under control of the reasoning powers, they are 
the source of all that is great and good in his nature, and contribute alike, 
both directly and indirectly, to health and happiness. 



BOOK THIRD. 



THE SICK-ROOM: 

ITS GEIEEAL MANAGEMENT. 



CHAPTER I. 
PRACTICAL HINTS ON NURSING. 

In very many cases the recovery of patients depends more upon the 
care which they receive than upon the judicious selection of medicines. 
The subject of nursing is therefore one of infinite importance, and deserv- 
ing of special consideration. No elaborate treatise on the art will be 
attempted in this chapter, but, in a rambling way, — in a series of hints, as 
it were, — the writer will discuss the subject generally, and reserve for 
further consideration the management in individual cases. 

The duties of a nurse are by no means confined to the mere adminis- 
tration of food and medicine, but in the care of a patient it is important 
to be ever on the alert, not only to minister to, but to anticipate the per- 
sonal wants. As numberless exigencies will constantly arise, dependent 
not only upon the nature of the disease, but upon the peculiarities and 
oftentimes the caprices of the sufferer, no rule alike applicable in all 
instances can be laid down ; but, in a general way, it may be said that 
much of the value of an attendant upon the sick will be measured by her 
watchfulness and thoughtfulness. 

Cleanliness, firmness, gentleness, and patience are certainly cardinal 
virtues in a nurse, and to these may properly be added strict temperance 
and fidelity. It is not only essential that the patients themselves, their 
clothing, and surroundings should be scrupulously clean, but personal neat- 
ness on the attendant's. part renders her far more acceptable. 

It is important to remember the close affinity which exists between the 
body and mind, and to appreciate that disorders of the former induce 
changes in the latter. As the physical system becomes deranged, the 
mental powers are weakened, and often the reasoning faculties are meas- 
urably impaired. Patients naturally amiable when in health not infre- 
quently become irritable and exacting when prostrate with disease. 

141 



142 PRACTICAL HINTS ON NURSING. 

When the judgment is distorted, the difficulties of the nurse will 
become greater, as necessarily she will be obliged to insist upon the per- 
formance of many duties against which the sufferer will remonstrate. 
Medicines are by no means invariably pleasing to the taste, and their 
administration is not always easy. Firmness is therefore one of the char- 
acteristics essential in attendants upon the sick. If a nurse is discerning, 
she will soon familiarize herself with the peculiarities of persons under her 
charge, and, this knowledge acquired, confidence in her judgment can 
then be successfully cultivated. It will be necessary to consult their pref- 
erences, and many little caprices doubtlessly may be harmlessly indulged. 
Concession on her part will engender a feeling of friendliness, under the 
influence of which it will be easier to enforce obedience when duties 
unpleasant to the patients are to be performed. 

Discipline is always needed in the sick-room, and rare intelligence, 
diplomacy, and patience are often indispensable in maintaining it. Rude- 
ness can never be tolerated, and an unnecessary display of authority is 
equally objectionable. Even in delirious patients force should be used 
only after persuasion has failed. A nurse should be calm, cool, yet sympa- 
thetic, and steadfast in her purpose to conscientiously discharge the duties 
assigned her. 

Ministrations to the sick should be characterized by gentleness, as a 
light touch is grateful to them, and from coarse contact they instinctively 
shrink. In certain painful affections especially, all duties must be per- 
formed with tender solicitude and a careful consideration, lest the sufferings 
be intensified. Awkward movements tell severely on a patient prostrate 
with rheumatism or injured limbs, and it should be the effort of all 
employed as nurses to acquire freedom of movement, dexterity, and pre- 
cision. 

One must never be unmindful of the fact, already referred to, that 
irritability and fretfulness are the general consequences of physical dis- 
orders. Invalids are often utterly unreasonable, and extremely perverse 
and obstinate. Nurses should therefore be able to endure many annoy- 
ances and provocations with calm and unruffled temper. Argument with 
sick persons rarely dissipates diseased fancies, and is quite certain to- render 
them still more uncomfortable. It will not be easy to content them, but 
every influence which tends to lessen their uneasiness and promote quiet 
must be beneficial. It is therefore essential to secure for the sufferer rest 
for the mind as well as body, and to protect him from all annoyances and 
vexing discussions. If the expression of the nurse is collected, cheerful, 
open, and winning, and her manner pleasing and gentle, it will aid her 
much in acquiring the good will and confidence of her charge, and, by 
inspiring hope, contribute not a little to the chances of recovery. 

The senses of invalids often become abnormally acute, and many little 
offices will be insisted upon which, to the attendant, may appear unreason- 



VALUE OF TRAINED NURSES. 1 13 

able and unnecessary. She should be obliging, find without hesitation or 
apparent reluctance perform all the duties required. Her earnest manner 
will be expressive of the deep interest she feels in the case, and thus will 
she gain the esteem of her patient, and insure obedience whenever her 

authority is exercised. 

Strict sobriety is one of the essential qualifications in a nurse. To their 
credit be it said, but few of their fraternity are addicted to the use of 
ardent spirits. Those who are intemperate, however, should never be 
allowed within a sick-room, as the habit, even if only occasionally and 
moderately indulged, renders them entirely untrustworthy. 

It is well for nurses to appreciate that in all cases where a physician is 
in attendance on an invalid, the responsibility rests solely upon him. His 
orders are to be faithfully executed, and the attendant's first duty is that of 
strict obedience. In many instances, measures are prescribed the necessity 
or wisdom of which is not apparent to the nurse; it is neither essential nor 
expected that the doctor should make her a confidante, or treat her to a 
dissertation on the physiological action of the drugs which he chooses to 
order for his patient. Whatever her private opinion of the course pursued 
may be, she ought never permit herself to indulge in unfavorable criticism. 
The public should know that notwithstanding a nurse may be well educated 
in her profession, and had years of experience, it is not only absurd but an 
evidence of dishonesty for her to assume a knowledge of the hidden work- 
ings of disease and the action of medicinal agents, with which only an 
intelligent and enlightened physician can be familiar. 

The number of nurses wise in their own conceit is, unfortunately? 
very large. Their influence is exceedingly pernicious ; they inspire doubts 
and feelings of distrust in the minds of patients and their friends, 
and thus often defeat the efforts of the me'dical attendant. Instances 
are by no means rare where lives have been sacrificed either by the 
failure to conscientiously carry out the instructions of the physician, 
or by the wanton intervention and substitution of other treatment by these 
dishonest meddlers, who have vain and lofty conceptions of their own 
abilities. 

An intelligent nurse, governed by the rules of right, can be of the 
greatest assistance to the doctor, and, if he finds her anxious to second 
his efforts, he will recognize her value, and the kindest of feelings will 
exist between them. If she fails to be candid and truthful, attempts 
deceit, and artfully endeavors to conceal from him her own mistakes, 
or anything of importance bearing on the case, she is treacherous alike 
to him and her charge, and is utterly unworthy the important duties 
assigned her. 

One fact it is important for nurses to remember, and that is that it is 
not within their province to preach religion. The sick-room is rarely the 
place for pious discussions, and if it so happens that the invalid is of a 



144 PRACTICAL HINTS OX NURSING. 

different persuasion than that embraced by the attendant, allusions to 
sacred subjects will more often invite controversies, which, by their dis- 
quieting' influence on the mind, can but prove injurious. 

In former years the ranks of the nurses were largely filled with elderly 
women, many of whom were wofully ignorant and unrefined. Seldom 
were their positions sought until the applicants had become superannuated, 
and until entirely incapacitated for ordinary duties. As a natural conse- 
quence, they were befittingly classed with housemaids and other under- 
servants. Within a few years, training-schools for the education of 
nurses have been established in connection with all the large hospitals, 
and many young ladies of ability and refinement have sought instructions 
and qualified themselves for an employment at once honorable and remu- 
nerative. The professional standard has been raised, and skilled and 
efficient nurses, of special and thorough training, are now highly appre- 
ciated by physicians, and society generally accords them the positions to 
which they are justly entitled. Whereas the ignorant and decrepit nurse 
was formerly a source of constant anxiety to the medical attendant, the 
educated woman who is now displacing her he finds of the greatest assist- 
ance, not only in carrying his orders into effect, but she aids him greatly by 
observing and informing him of symptoms and important changes which 
occur in his patients during his absence. 

Thus far, certain general rules have been discussed which should 
govern the conduct of professional nurses. In all cases where one is in 
attendance, much of the care of the invalid will naturally devolve upon 
her. Still, near relatives, familiar with the disposition and peculiarities of 
the patient, can be of great assistance, and, while not interfering with her 
duties, should do all they can to aid her. It is important for them to 
remember, what too many forget, that nurses are human, and there is a 
limit to endurance. They should be allowed sufficient sleep, and an occa- 
sional release from their burdens and duties. It is by no means rare for 
people, cruelly thoughtless, to forget their duty to the attendant, and the 
more observing physician is often obliged to remind them that they are 
overtaxing her strength and endangering her health. 

While the employment of skilled and experienced nurses contributes 
to the chances of a patient's recovery, the number who will avail them- 
selves of their services will be comparatively small by reason of the 
expense, which many can ill afford. If the management of the sick is 
assumed by friends or near relatives, they, in as much as possible, should 
conform to the essential rules which the professional attendant is expected 
to observe. They ought never to forget the difference between them- 
selves and the sufferer, and should feel that, as the body is prostrate 
with disease, the mind is distraught nnd its controlling power weakened. 
Their patience will be sorely tried, but even mild reproofs, which rise 
so easily to the lips, should never find utterance. Many patients are 



THE SICK-ROOM AND FURNISHINGS. 1 15 

rendered so extremely sensitive by disease, a word, a look even, indica- 
tive of reproach, is construed as harshness, and is often sufficient to 
seriously affect the nervous system, and increase its morbid susceptibility 
to excitement. 

Much discretion and judgment are therefore necessary, in caring for the 
sick, to maintain the influence over them which is essential in the treat- 
ment of all diseases. The conduct of attendants should be uniformly mild 
and sympathetic ; they should endeavor to control ebullitions of temper, 
not by injudicious opposition or expostulation, but counteract them with 
compassionate indulgence and patient solicitude. 

THE SICK-ROOM AND FURNISHINGS. 

Not only the comfort and well-being of invalids, but also their chances 
of recovery, depend to a great extent upon their surroundings. The sick- 
room should be large, light, and airy, and, if the illness be of such a nature 
that quiet must be enforced, then it should be as remote as possible from 
the noises of the house and street. When the patient is suffering from an 
accident, his wishes may be consulted, and very likely a room near the rest 
of the family will be preferred ; he will be more cheerful and contented if 
he can see them often and enjoy their society. 

If a choice of rooms is possible, one on the sunny side, having a south- 
ern or westerly aspect, should be selected. Only in exceptional cases, 
such as inflammation of the brain or eye, is it necessary to choose a dark- 
ened room ; in all other diseases light and sunshine should freely enter. 
The former has been aptly termed a healthy stimulus, and nothing is more 
absurd than the ancient custom, transmitted by ignorance, of at once seal- 
ing up windows, irrespective of the disease from which the occupants are 
suffering. " Where the sun does not enter the doctor does," is an Italian 
proverb rich in practical truth. The cheering influence of sunshine is 
even subordinate to its actual physical effects, which are alike essential 
to the growth and healthy development of the animal and vegetable 
kingdoms. 

No unnecessary articles of furniture should be permitted in a sick-room, 
and those in actual use should be of the simplest construction. Curtains 
of cotton or linen only are allowable, as woollen fabrics easily become 
infected, and permit the accumulation of dust. Covered chairs should be 
replaced with those cane-bottomed or of plain wood, and carpets even may 
properly be dispensed with. If rugs are used, they should be small enough 
to admit of being daily removed, shaken, and well aired. 

Rigid simplicity should, in fact, characterize all the belongings of a 
sick-room ; otherwise it will be difficult to maintain absolute cleanliness. 
In the absence of ornaments, the removal of which it is necessary to insist 
upon, as they afford lodgement for dust, their places can be filled with grow- 



146 TEA L HINTS N NURSIHG. 

ing plants or cut flowers, which will relieve the monotony and render the 
: brighter and more cheerful. 
It is especially necessary that an invalid's apartment be free from 
all offensive odors, and communications with it by which it is possible for 
foul air to penetrate should be at once cut off. Stationary basins on<rht 
be sealed, even though they are provided with the most approved 
arrangement of traps. They are a source of danger, notwithstanding, and 
only by closing completely the overflow holes, and filling the bowls with 
water, can perfect safety from sewer-gas be assured. If a door cohl - 
the invalid's room with the bath-room, the strictest sanitary precautions 
should be observed. As a general rule, it will be well to cut off all com- 
munications between the two apartments, and to close up the crevices 
around the door with paper firmly wedged into them. 



VENTILATION AND HEAT. 

It -Lould not be forgotten that in many diseases recovery depen«i- less 
upon the use of drugs than upon judicious nursing and a wise observance 
of the laws of hygiene. Ventilation is always of primary importance; 
the emanations from the patient are constantly contaminating the air, and 
its purification should be continuous. In warm weather there can be but 
little difficulty in securing an abundance of pure air, but dnring the wicter 
months to maintain proper ventilation is much less easy. Even tempera- 
ture m^-- sacrificed :o a considerable extent in order to obtain 
xh air, if a choice requires to lie made between them. It is important 
to remember that there are other impurities besides those exhaled 
the lungs and thrown off by the skin ; the immediate dilution of dis- 
charges and as speedy removal of them as can be managed are essential. 
The quantity of air demanded for a sick person, especially if suffering 
from an acute disease, is relatively greater than that required by a person 
in health. 

The renewal of air in the sick-room should be carried on by continuous 
ventilation, for a small current of fresh air mixing with the larger volume 
is more easily broken up, and thus direct draughts are avoided. The win- 
dows of all invalids 5 apartments should be adjusted so that they will open 
easily both at top and bottom. A current of cold air should always be 
directed upwards, and this can be effected by numberless little levices. 
Bv raising the lower sash and closing the opening at the bottom with a 
board, the air is allowed to enter at the middle only, and is deflected 
towards the ceiling. Or if the board is fitted to the bottom of the window- 
casing, then when the sash is raised the current is interrupted and directed 
upwards. 

constant currents are r . — one outward, removing the 

impure, and one inward, supplying pure air. The inlets and outlets should 



BEDS AND BED-MAKING. 147 

be on opposite sides of the room, and as far removed as possible from the 
patient. An outflow of foul air is best secured by an open fireplace. 
Stoves, in the same way as grates, but to a much less extent, assist 
ventilation. If the room in which the invalid is confined is very small, 
in intensely cold and stormy weather it may be inadvisable to open the 
windows in his apartment. In such cases, into the room adjoining fresh 
air may be admitted from the outside, and warmed before it is allowed to 
reach the patient. 

The temperature of the sick-room, when the patient is confined to the 
bed, should be between 56° and 60°, unless otherwise ordered by the phy- 
sician. To steadily maintain this with free and perfect ventilation in cold 
weather, there must necessarily be a surplus of heat. Open grates or 
stoves only should be used, as furnace heat, being very dry, is especially 
forbidden, as injurious to invalids. In all instances, however the sick-room 
is heated, a pan of water should be provided, to dampen the air by its evapo- 
ration. 

BEDS AND BED-MAKING. 

The subject of beds and bed-making is one deserving special considera- 
tion. Its importance is too often underestimated, and the comfort of 
patients, acutely sensitive to every trifling annoyance, is seriously affected 
by confinement in an ill-conditioned bed. The wooden bedsteads fashion- 
able at the present time are not only too large, heavy, and with difficulty 
moved, but their carvings afford lodging-places for dust, and defeat the 
efforts to maintain absolute cleanliness. 

Bedsteads should be light and easily movable. Those commonly used 
in hospitals, and constructed of iron or brass, with a mattress of woven 
wire, are far superior to the elaborate structures ordinarily found in private 
houses. It is a great disadvantage to have a bed too wide. If the patient 
be in the middle and needs help, the attendant is obliged to lift either 
kneeling on the bed, or at arms' length, a position which soon exhausts 
her strength and causes a very painful strain on the muscles. If forced to 
use a wide bed, it is better to divide it down the middle with a board a 
few inches high, covering the same with the under bedclothes. 

To favor convenience, the bed-frames should be at least two feet and 
not over two and one-half feet high. A hair mattress is to be preferred, 
but, by reason of its expensiveness, one made of cheaper material will 
be more commonly used. It is important only that the bed be clean 
and firm, not soft ; under no consideration whatever is one of feathers 
allowable. Neither in sickness nor in health can a good reason for its 
use be advanced, while numberless objections condemn it as unwholesome 
and injurious. 

The custom of placing a blanket over the mattress is not a proper one, 
and between it and the under sheet nothing need be interposed. If it 



148 PRACTICAL HINTS OS NURSING. 

'lies necessary to protect the bed from the discharges of the patient, a 
• should be used, folded several times and placed on a piece 
of rubber sheeting or enamelled cloth, or. in cases of emergency, heavy 
brown paper will make a fairly good substitute. This folded sheet, with 
its protecting layer, can easily be drawn under the hips of the invalid, and 
changed, when necessary, with but very little effort or disturbance. 

As in health, the upper clothing should be sufficient to keep the 
comfortably warm, but no more. If the coverings are too heavy, respira- 
tion is interfered with, and the patient is weakened if overheated. The 
upper sheet, if well tucked in at the foot, will be less easily deranged by 
the sufferer's restless movements. Aged people and children may need to 
be placed between blankets, and there are certain diseases, among them 
rheumatism, in which their use is preferable to sheets; but. as a general 
rule, the latter are infinitely more comfortable, and assuredly they are 
more wholesome. 

In long and tedious illnesses, two beds for the patient's use are actually 
necessary. Changes then can be easily made, and all the belongings 
exposed each day to the outside air and sunshine. If the beds are of an 
equal height, they can be pressed closely together, and even if the invalid 
is utterly helpless he can be easily drawn from one to the other. When 
one bed only is allotted to the sufferer, the under bedclothes can be 
changed with but very little disturbance to him. To do this it is necessary 
to proceed in this way : roll up the sheet to be removed, to the middle, 
lengthwise, not across the bed: put on the clean one. with half the width 
rolled up, close to the other roll ; then the patient can be lifted or turned 
over on to the newly made part, the soiled sheet drawn off. and the clean 
one unrolled. 

To change the upper coverings without exposure, first free them at the 
foot of the bed, spread the clean sheet over them, and cover it with a 
blanket. These should be well tucked in at the sides, and then the soiled 
clothing can be drawn down and removed at the foot. The custom of 
many is to replace the soiled lower sheet with the up] iously in use. 

In the sick-room, especially, this is not a good practice, as it is essential to 
the comfort of the sufferer that the clothing under him be fresh and 
smooth. 

Sheets should be changed daily; if it is impracticable to replace them 
with others perfectly clean, it will be well, at least, to have two sets in use. 
that they may be each day dried r.nd well aired. Pillows should be firm 
and elastic ; as they soon become hot and uncomfortable, they will need t<> 
be frequently changed, or shaken up and turned. Fresh, clean pillow-sli} s 
are an economical luxury which can always be afforded, and need never be 
denied an invalid. 



BED-SORES — CAUSES AND TREATMENT. 149 



BED-SORES. 

It is pertinent to the subject under consideration to refer to bed-sores, 
their causes, and treatment. When patients are long confined in bed with 
very tedious and debilitating maladies, such as fevers, paralysis, and old 
age, and especially if they are too weak to change their positions often, the 
skin covering various projecting bony parts is liable to inflame, and rapidly 
ulcerate or slough. These sores appear most frequently upon the lower 
part of the back, the hips, shoulders, elbows, or heels, and are hastened by 
neglect of cleanliness, or by contact with urine. They are especially 
prone to appear in cases where the spinal cord has been injured. 

The first symptom evident to the patient is a prickling sensation, such 
as would be induced were he lying on fine particles of salt. The part, if 
examined then, appears red and roughened, the skin over it soon breaks, 
an ulcer forms, or the tissues turn black and mortify. These sores, when 
once formed, are very intractable, and a cure is extremely tedious and diffi- 
cult. It is obvious that every means should be employed to prevent their 
appearance. In all cases where confinement to the bed is at all likely to 
be protracted, the precautionary treatment should be commenced in the 
first stao;e of the disease. Absolute cleanliness of the cloth in <* should be 
enforced ; the under sheet ought never to be allowed to wrinkle or remain 
damp, and especially is it important to keep it free from crumbs, or any 
rough particles which are often deposited in the beds of invalids. 

The projecting bony parts subjected to pressure should be frequently 
washed with soap and water, thoroughly dried, and then bathed with 
alcohol or eau de Cologne. By this means the skin will thicken, harden, 
and be enabled to bear pressure better. After the parts are dried, it will 
be well to apply some simple ointment, such as vaseline, and then dust on 
powdered starch, or the oxide or the oleate of zinc. A water-bed should 
be had, if possible ; if not, the patient's position should be frequently 
changed, so that the weight may not be felt continuously in the parts most 
likely to be affected. When, notwithstanding the precautionary treatment, 
the skin is broken and a bed-sore is inevitable, it should be covered with a 
broad piece of soap-plaster, and pressure on it relieved by circular pads or 
air-cushions. 

If the parts ulcerate, the oxide of zinc ointment should be applied. 
When a slough has formed, its separation may be hastened by charcoal or 
chlorinated poultices. After the mortified part is removed, the poultices 
should be discontinued, and the cavity dusted with a powder made up of 
iodoform and oxide of zinc, one drachm of the former to one ounce of the 
latter. It will be convenient to employ a small bellows in using this 
powder. After the application, which ought to be made twice daily, a pad 
of absorbent cotton should be placed over the sore and covered with a 
piece of oil-silk. 



150 PRACTICAL HINTS ON NURSING. 



GENERAL RULES. 



Returning to the general management of the sick, there remain for 
consideration a few important rules. The need of absolute cleanliness 
cannot be too strongly emphasized; it should be apparent everywhere 
about a sick-room. Each day, once or twice at least, the face, arms, hands, 
and armpits of the patient should be sponged with soap and water, and a 
general sponge-bath given whenever permitted by the attending physician. 
Soiled linen dressings from a wound, and all other offensive things, should 
be immediately removed. Every article in use should be kept scrupulously 
clean, and occasionally exposed to the open air. Drinking-water should 
never stand long without being changed, as it absorbs the impurities in 
the air. If a patient's appetite is capricious, and he will not eat the food 
brought to his bedside, then it ought to be at once taken from the 
room. Medicines should be banished, excepting at the moment of admin- 
istration. 

The rocking of a chair, rustling of garments, and squeaking of shoes, 
are sources of no little annoyance, and all sharp, sudden sounds, like that 
made by the falling of a metallic substance on a bare floor, are startling to 
a patient whose nervous system is disordered. If the fire must be raked, 
a wooden poker is much less noisy than one of iron ; if more coal 
is needed, it can be brought in wrapped up in paper, and placed without 
sound within the stove. In addressing a patient, the voice should be clear 
and distinct. Under no condition is whispering in the sick-room excusa- 
ble. This custom, which is so frequently indulged in by well-meaning and 
solicitous friends, is extremely distressing to the patient, as it tends to 
excite apprehension, and suggests a concealment of unfavorable features in 
his case. As has been very wisely remarked, "It should be laid down as a 
rule that whatever the patient is not intended to hear should not be said 
in his presence." 

In all cases where an invalid is seriously ill, or where much depends 
upon the most careful observance of the physician's directions, the attend- 
ant should not trust solely to memory, but carefully note down all his 
orders, and during his absence keep a record of the unusual manifestations 
and important changes. As eacli dose of medicine is given, it should be 
registered ; thus regularity will be insured, and the practice will prove of 
especial convenience in case different members of the family share in the 
nursing. It is important, among other things, to note any unusual appear- 
ance in the character of the urine and intestinal discharges. It is also well 
to estimate, with a near degree of certainty, the quantity of nourishment 
taken by the patient. The coming of the attending physician should be 
anticipated by having everything in readiness which he is likely to need. 
It is especially annoying to him, and distressing to the patient, if the 
attendant is continually obliged to leave the room for little things which 



GENERAL ItULES. 151 

a measure of thoughtfulness would have prompted her to provide previous 

to bis coming. Among other attentions, have in readiness the conve- 
niences for him to wash his hands before leaving. The nurse should give 
the medical adviser her whole and undivided attention while he is making 
his visit. In describing the important changes she should confine herself 
to facts, as those are more essential to him than mere opinions ; he should 
not be harassed with speculations and obsolete theories, and by all means 
her language should be clear, concise, and to the point. 



CHAPTER II. 

DIETETIC TREATMENT OF THE SICK. 

The subject of dietetics, scarcely second in importance to that of medi- 
cinal treatment, is ably discussed in the following editorial from the Journal 
of Reconstructives. 

It has been noted as a sign of medical progress at the present day that 
physicians are giving somewhat less medicine than formerly. There is, 
moreover, a growing scepticism as to the efficacy of many of the older 
remedies, a growing tendency to abandon the use of the more powerful 
drugs for specially prepared and easily assimilable pharmaceutical products. 

Nor is this all, for such a movement is merely negative. There is 
another tendency operating at the same time, which possibly is of far 
greater import. Side by side with the increased distrust of the Materia 
Jfedica of our fathers, there is a tendency positive in its character, a ten- 
dency perhaps destined to open up a path wider and farther reaching than 
any opened up for many a day. 

The new departure which, it is claimed, is to form an epoch in medi- 
cine, if not to effect a revolution in medical practice, is told in three short 
words, — feed the patient. All diseases tend to reduce, to weaken and 
wear out the system. The required medication often tends to still greater 
debility. " We see," says Trousseau, " alterative medicine hindering and 
destroying the action of the plastic force, opposing the changes of living 
chemistry by weakening the nutritive properties of the blood and the 
tonicity of the solids." Fever, according to Austin Flint, is literally a 
burning-up of the system. These deep inroads upon the human frame 
make it all-essential that a work of repair, a filling-up and building-up, a 
reconstructing of the worn and shattered constitution, should be under- 
taken without delay, even simultaneously with the efforts directed to find 
out the disease, its nature and seat, and to operate for its removal. 

The keynote of the new departure was sounded by John Hughes Ben- 
nett, the eminent Edinburgh practitioner, the first to use cod-liver oil in 
phthisis, when he said, "Disease is something less than life.'''' What we 
must do is not to depress and reduce, but nourish and keep up, restore the 
life that is being drained, build up the tissues that are being wasted. 

152 






A NEW SYSTEM OE THERAPEUTICS. 153 

The good fruit which such principles as these have borne, and are just 
now especially beginning to bear, is most gratifying to see. One may cite, 
for example, the emphatic statement of M. Jaccoud, one of the foremost 
physicians of France: "Phthisis is curable, and curable at every stage," 
and this by proper attention to the patient; by proper air and tempera- 
ture, and surroundings, but more especially by proper diet. The remark- 
able little book of Weir Mitchell, on the making of fat and blood, may 
be mentioned, and the excellent studies on diet by Tom King Chambers, 
the writino-s of Bauer in Vienna, and the investigations of Roberts and 
Fotheroill iu England, all point in the same direction. It is even rumored 
there is a movement on foot for the establishment of a chair of dietetics in 
medical schools throughout the United Kingdom of Great Britain and 
Ireland, and the same thing has been suggested for America. 

If the movement is successful, it will initiate changes. Medical prac- 
tice may not be revolutionized, but it may be gradually modified by the 
prominence given to several hitherto neglected departments, and the com- 
parative neglect of others hitherto regarded as all-important. 

Instead of dwelling at great length on cathartics, alteratives, and 
expectorants, an opportunity will be afforded the professor to discourse 
eloquently on aliments, haematics, and reconstituents. Instead of the 
headings, "Therapeutics and Materia Medica," in the text-books, the 
student will read, " Dietetics, Therapeutics, and Materia Medica." " Die- 
tetics," says Dr. Roberts, in a recent address, "cover more ground 
than any other branch of the healing art." Nothing can be truer. 
The one thousand one hundred and twenty-six diseases of the nomencla- 
ture all have one thing in common, they all reduce the patient — 
so do many of their remedies. Any practice which counteracts this 
tendency must certainly cover more ground than any other branch of the 
healing art. 

Here is a field of operation ! an endless opportunity for experiment, a 
scope for investigation and discovery unlimited ! Why should not each of 
the one thousand one hundred and twenty-six diseases have its appropriate 
counteracting food, as it now has its counteracting remedy? Why should 
we not have manuals of alimentary therapeutics, as well as manuals of 
alterative therapeutics? Why may we not have diet-rolls for other dis- 
eases than gout and diabetes, other food-specifics besides cod-liver oil for 
phthisis? Why may not the initial attempt at the classification of foods as 
flesh-formers, combustibles, and mineral-producers, be pushed on till a true 
science is created, and we have foods differentiated for membrane and for 
muscle, for nerve and for parenchyme? Why may Ave not have a "Materia 
Dietetica" in which the student shall learn what he can build up or restore 
with aliments or reconstituents, as he has already learned, often too well, 
what he can combat and drive out with alteratives, evacuants, and the 
nervina depressovia. 



154 DIETETIC TBEATMBNT OF THE SICIC. 

It is believed that the present tendency among our best physicians 
largely to substitute food instead of medicine in the treatment of disease 
is not to be looked upon as a mere fashion, like hydropathy, the hot-water 
treatment, and other similar ephemeral movements. The dietetic move- 
ment may certainly be said to have a wider and deeper meaning. "The 
effects of diet," says Dr. Roberts, "are profound and far-reaching, and 
cannot be overestimated;." Indeed, the present indications are that a 
change in the relations of food and medicine is slowly taking place, simul- 
taneously along with changes in the relations of physiology to pathology. 
Just as pathology seems to be turning into physiology, so therapeutics 
seem inclined to undergo transformation in the direction of dietetics. 

For something more than a generation, — ever since the present-century 
inquiry into the origin and workings of cell-life has begun to bear fruit, — 
the conscience of the physician has been growing tender. The usual reme- 
dies are often of a nature injurious to the organism. We have heard 
repeated the wise and witty remark of Dr. Holmes, that if all the apothe- 
caries' bottles were emptied into the sea, it would be all the better for men 
and all the worse for the fishes. It stands, of course, confessed that some 
of the remedies in use from time immemorial are essentially antagonistic 
to the organism, many of them in effect depressing, devitalizing. 

In the heroic mode of treatment, then, the physician followed the Jesuit 
rule of doing a little evil that good may come. In the more modern prac- 
tice, the physician enacts the very different part of the Good Samaritan, 
and pours in oil and wine. However else he may fail or come short, he 
rests in the certainty that, when administering such things as oil and wine, 
beef, wheat, and milk, in easily digested forms, the active principles of 
grains and fruits, he is doing nothing but good to the patient. He is 
offering to the organism ingesta that are acceptable, things that belong to 
it, things that are required in its reconstruction. Until such time as we can 
find out the specific germ of the disease, study the conditions of its life, as 
the Germans are now studying bacteria, and operate directly for its exter- 
mination, one of the best things to do, it would seem, is to try to build up 
and keep up the patient. 

Twenty-five years ago our old-fashioned drugs were counted by thou- 
sands, our elegant pharmacal products by tens, dietetic preparations by 
units. If the change goes on in the next two decades as rapidly as it has 
in the last two, the coming-century practice will see this order reversed. 
The calomel, the jalap, the Epsom salts, the tincture of iron, — these 
classics and venerables, though still in use doubtless, will find very little 
favor. Even now their regular employment seems to be a kind of 
reproach, excusable only on the ground of the great age of the physician, 
or the poverty of the patient. 

What kind of food do we need for the sick? The most nutritious and 
the easiest digested. Mother's milk, as it leaves the breast fresh and 



DR. ROBERTS ON DIETETICS. 155 

warm, is quickly transformed into living blood in the infant's veins, but a 
slio-ht chemical change being required. The digestive functions of the 
child are at first feeble, consequently Nature supplies the lacteal fluid par- 
tially ready for assimilation ; or, in other words, the casein of human milk 
approaches in solubility a peptone. 

Is it possible to obtain a food as easily transformed as human milk, but 
more nutritive ? In many forms of disease, the condition of the stomach 
renders it incapable of performing but slight mechanical labor; the secre- 
tions of the digestive tract are deficient, the waste is great, and the repair 
inadequate. We need in such cases highly nutritious and easily digested 
foods. There is but little to meet these requirements in beef-teas, soups, 
essences, broths, Liebig's extract, etc., consequently the waste is much 
greater than the repair, and patients fed on them starve. The great secret 
of success in the treatment of most diseases is to keep up vitality, and 
supply waste of tissue with easily digested food. 

Dr. William Roberts, F. R. S., of Manchester, delivered an address to 
the British Medical Association, at its annual meeting, at Cardiff, in July, 
1885, on therapeutics, in which he took for his topic, not medicines, but the 
feeding of the sick. In it he said : " So far as I know, there is no system- 
atic teaching of dietetics, even on the most limited scale, afforded to the 
student at any of our medical schools. He (the medical student) is left to 
pick up his knowledge of this subject as best he may, during the earlier 
years of his practice ; and he often ends by taking his own digestive 
organs as his type, and prescribes for his patients according to the lik- 
ings and dislikings of his own stomach." Dr. Roberts holds this to be an 
unsatisfactory state of affairs, and detrimental to the patient's interests ; 
while it is the cause of the " contradictory advice which is tendered to 
invalids." 

He continues : " Perhaps, of all the many duties which fall to the prov- 
ince of the medical practitioner, there is none so common as the duty of 
regulating the diet of his patients. Whatever the disease may be from 
which the patient is suffering, and whatever special means may be indicated 
for his relief, the regulation of the diet is sure, sooner or later, to crop up as 
an integral part of the management of the case. Dietetics, therefore, cover 
more ground than any other branch of the healing art ; they are also, 
perhaps, the most ancient branch. Hippocrates traces back the very origin 
of medicine to dietetics. 'For,' he says, 'the art of medicine would not 
have been invented at first, nor w T ould it have been made a subject of inves- 
tigation, if, when men are indisposed, the same food and other articles of 
regimen which they eat and drink when in good health, were proper for 
them, and if no others were preferable to these.' Notwithstanding this uni- 
versal applicability and this high antiquity, it must, I think, be allowed 
that dietetics, except in a few special cases, are somewhat neglected in 
these days. The often contradictory advice which is tendered to invalids 



156 DIETETIC TREATMENT OF THE SICK. 

in regard to their diet by the several medical men whom they may consult, 
betrays the want of a guiding principle, and of a general consensus of 
opinion in the medical profession on the subject of feeding the sick. This 
is perhaps not to be wondered at, when it is considered how little system- 
atic study is devoted to dietetics, and how fragmentary is the instruction 
on this subject which is given to the student of medicine. . . . There is, 
perhaps, no subject on which individual experience is so fallacious a guide 
as dietetics, and none in regard to which it is more important to draw our 
inductions from a wide basis of facts." 

Dr. Fothergill says: "Systematic teaching can only become possible 
when a text-book — alike for teacher and student — is un fait accompli; 
and it does not yet exist. We have works on food by King Chambers, 
Pavy, Sir Henry Thompson, the writer, and others; interesting, instructive, 
but incomplete. Of the urgent necessity of some such systematic teaching 
there can exist no doubt. As a case in point, take beef-tea. In every 
house more or less beef-tea is made when there is any sickness in the 
household. Marvellous properties are ascribed to it; yet, in the main, it is 
an impostor — as ordinarily made. It is a stimulant, with a value bearing 
no proportion to its cost. But it is not a food, whether made at home or 
not. By the mode of preparation, it is a stimulant, from the presence in 
it of nitrogenized principles, which are past the tissue-stage, and, therefore, 
are useless as ' tissue-food,' while their ' fuel-food ' value is little more than 
nil. It certainly contains valuable salts, as the phosphate of soda, for 
instance. But it is not a food, and to give it to a hungry man is 'to give 
him a stone when he asks for bread.' However unpalatable this statement 
may be to physicians, nurses, housewives, and attendants upon the sick, — 
who have differed from the French physicians who bled their patients 
diete, in that the one openly starved their victims, while the latter attained 
the same end unconsciously and unwittingly, — the sting of it lies in its 
truth. Writer after writer on food has pointed this out, and insisted upon 
the addition of some of the meat-fibre (pounded to a paste) to the tea, 
with about as much effect upon the public mind as would an assault made 
upon the fortress of Gibraltar by one man, with a crowbar, have upon the 
famous rock. But if every medical student was taught that beef-tea is 
no more than a pleasant stimulant, agreeable to the palate, acceptable to 
the stomach, but in no sense of the word a true food, then a more correct 
and less homicidal view of the true value of beef-tea would soon be uni- 
versal. (The term 'tea' is appropriately applied to meat-infusions, as the 
extractives of meats have a chemical composition — as well as a stimulant 
action — very closely resembling that of theine and caffeine; so that the 
effect of a cup of beef-tea is very much like that of tea, 'the cup which 
cheers, but does not inebriate.') In possession of such knowledge, he would 
not give beef-tea as a food, but as a 'food-adjunct.' He would not discard 
beef-tea as useless; he would still value it as a delightful beverage, possessing 



PROPER ADMINISTRATION OF FOOD. 157 

stimulant properties, and give it a food-value by adding to it some baked 
flour or other soluble carbo-hydrate. 

" In the treatment of the acutely sick, the resort to beef-tea, now so 
prevalent, has done incalculable harm. In the mistaken belief that it is a 
food, numberless sick persons have been allowed to slip into their graves, 
without any one having a suspicion even of the actual facts. At the 
London Fever Hospital beef-tea is given sparingly, as a stimulant beverage 
of doubtful value ; but then, the resident medical officer of that well known 
institution has, to my personal knowledge, given considerable attention to 
the subject of dietetics and the 'food-value' of various foods." 

In a considerable number of conditions, patients are unable to take 
solid food, and their nourishment must necessarily be administered in the 
liquid form. This is usually the case in fevers, and in disorders of the 
abdominal organs; also in the later stages of nearly all diseases. There 
are many other conditions in which, although the patient may have the 
ability to take solid food, it is inexpedient that such food should be admin- 
istered to him. Considering the wide field for the employment of liquid 
food, it is to be deplored that, as yet, the resources are extremely limited, 
and it is often exceedingly difficult to devise food in this form in sufficient 
change and variety, and having at the same time a proportionate degree 
of nutritive value. 

When a physician is in attendance upon a patient, he will direct the 
dietetic treatment. It is, however, essential that the nurse, or those 
employed in nursing, be familiar with the proper methods of preparing 
food for the sick, and the manner in which it should be administered. It 
is necessary to fully realize the fact that in nearly all diseases one of the 
first symptoms is loss of appetite. There are few duties in the sick-room 
which demand such thought fulness, patience, and good judgment as the 
judicious feeding of invalids. Many are not merely disinclined to take suf- 
ficient food, but they are also often so extremely perverse and obstinate in 
their refusals, its administration is attended with the greatest difficulty. 

Dr. R. M. Hodges says: "To secure a constant and sufficient conversion 
of food material by those who are or have been insufficiently fed, vigilant 
supervision is often requisite. The personal influence which accomplishes 
this is a variable possession. Some persons can win obedience where others 
might capitulate, and will exhibit a persistency in carrying out their sug- 
gestions which makes successful feeding a certainty, when more lenient and 
compromising tactics would fail. Enfeebled subjects, especially women, 
often feel a great satisfaction in being controlled, and in being led, lifted, 
pushed, by a strong will. With such individuals, resolute oversight tells. 
That which they say in regard to eating they 'cannot do,' they are made 
to do. When they think they 'do their best,' they are compelled to do 
more and better, and an assertion that they will 'try' to eat is counter- 
balanced by a determination that they shall succeed. No symptom of the 



L58 DIETETIC TREATMENT OE THE SICK. 

hich results from being underfed is more characteristic of the 
condition than the almost invariable obstinacy of its subjects to accept 
advice which suggests an increase in their consumption of nutriment, and 
- :. - curing a mutual understanding between physician and patient 
are so difficult as those directed to overcoming the d __ 1 resolution and 
pertinacity which are manifested in this respect. 

__ I way, however, maybe smoothed by various procedures. 
need not be made unnecessarily hard to travel. It is helped by i 
ing food containing the most nourishment and the least bulk, and which is 

- st to swallow after a minimum of mastication, or without any. 1 
culinary art facilitates the ingestion as well as the digestion of meats, which, 
without it's cajolery, might be tough and uninviting. Skilful : by a 

nurse who recognizes the art which may be exhibited in coaxing food into 
the stomach, is often of advantage. Food thus administered must be 
introduced in large mouthfuls. Every gourmet knows how necessary this 
is for the satisfaction of the palate, and the correctness of the fact is sub- 
stantiated by reason and by analogy. Well shaj ly masoned, large 
morsels make a relishing and appetizing mouthful, inviting repetition. In 
divided bits they quickly satiate or excite repuguance. By this epicurean 
method, the stomach is rapidly and persuasively charged with a sufficient 
supply of nourishment, as it never can be by the feeble pickings of an 
apathetic eater. -Z" - en mangeant* is a paradoxical adage 
stantly verified. Not only mere disinclination to eat is ften success- 
fully overcome by persistent feeding, but a liking for and dependence upon 
full and hearty meals is established, and, what is more, retained." 

FOOD AND ITS ADMINISTRATION. 

Food for invalids should be of the very best quality, skilfully cooked, 
and palatably seasoned. It is also important to observe absolute cleanli- 
ness in the service, which should be tasteful and attractive. In nearly all 
severe illnesses the digestive powers are measurably weakened, and, to 
avoid overloading the stomach, and yet nourish and sustain the vitality 
that is being wasted, it will be necessary to divide the food into suitable 
quantities, and give it at regular intervals. When such conditions exist, 
regularity is of infinite importance. The custom of many, of administer- 
ing nourishment spasmodically, without regard to method, is a most per- 
nicious one. It should be given punctually at fixed hours, with a sufficient 
interval to obviate the danger of overtaxing the digestion. 

The rule never to awaken a patient to administer food or medicines, 
while a very sensible one, still admits of several exceptions. There are 
cases where regularity must be observed, even at the expense of sleep. In 
certain acute diseases, among them pneumonia, the stimulant and support- 
ive treatment must be continuous, and the svstem constantly under its 



FOOD-VALUE OF MILK. 159 

influence. In such cases, if too long an interval were allowed, a fatal 
depression might ensue in those in whom the vital energies were taxed to 
their utmost by the intensity of the disease. 

While patients are conscious, hut helpless, all liquids should he taken 
by suction through a glass drinking-tube. In feeding delirious or uncon- 
scious patients, great care must be used lest the liquids be drawn by inspira- 
tion into the air-passage. The head of the patient should be supported, 
and the nourishment administered with a spoon. In cases where it is diffi- 
cult to make them swallow, tapping the cheek gently with the spoon, or 
speaking quite loudly to them, will often induce an instinctive performance 
of the operation. 

Thirst is essentially a symptom of fever. Unless persistent vomiting 
contra-indicates its use, water should never be denied a sufferer. When 
ice-cold, it is one of the agents which can be relied upon to reduce high 
bodily temperature, and nothing can be more grateful and refreshing to a 
patient in a burning fever. Slightly acidulated drinks can rarely be inju- 
rious to patients; still, there are conditions in which they are not allowable. 
The quantity of acid should be small in all instances, as an immoderate use 
is liable to cause gastric and intestinal irritation. 

The resources in feeding the sick consist of milk, beef-tea and other 
meat-decoctions, cold-made meat-infusions, raw eggs, and the various gruels. 
Milk is the most serviceable and desirable of liquid foods. It is capable 
alone of sustaining life, and it forms the basis, or enters into, very many 
preparations used in feeding invalids. Milk can be given alone, or with 
tea, coffee, or cocoa, or with lime-water, soda-water, or alcoholic stimulants. 
It is an essential in the various gruels, and in the form of buttermilk, 
koumiss, or whey, it is useful in certain disordered conditions. Were it 
not for the necessity of change and variety, in a large number of cases 
milk alone would be quite sufficient support and nourishment. Its con- 
tinued use, however, excites aversion, and other liquid foods must be sub- 
stituted. 

Occasionally patients will complain that milk "always disagrees with 
them." In such cases mere prejudice may be active, but more often actual 
gastric disturbance does follow its use. One reason, doubtless, is that it 
is drank too quickly, and forms in the stomach one hard and unbroken mass 
of curd, which is with difficulty acted upon by the digestive fluids. Were 
it drank slowly, sipped as it were, it would then be distributed throughout 
the stomach, and eventually form in a spongy mass filled with cells, in and 
out of which the fluids could freely play and perform their functions. 
Another reason assigned for the indigestibility of milk in certain cases is 
its deficiency of cream. When the proportion of this element is lessened, the 
curd which forms is harder and more compact. As has been said : "Milk 
is often too poor but never too rich for purposes of enforced nutrition, and 
the fact is incontrovertible that it is the model food for digestibility. By 



160 DIETETIC TREATMENT OF THE SICK. 

adding cream to milk, the amount of fat is increased and the curd is soft- 
ened : its digestion can be still further facilitated by the disintegration of 
its coagula, accomplished by crumbling into it bread, crackers, etc., or by 
the addition of a small amount of cooked meal or flour." It should be 
remembered that there is a great difference in the palatableness as well as 
the digestibility of cream which is obtained by machinery, as is largely 
done for the market, and that which is skimmed after "setting.'' The latter 
product is by far the most desirable article for use in an uncooked form by 
invalids. In cases where milk is largely depended upon as food, if given 
warm, and with the addition of a small amount of tea, coffee, or cocoa, an 
agreeable change is afforded. 

Very rarely indeed are conditions met where milk judiciously admin- 
istered is not properly digested. It is not impossible, however, that, 
in certain inflammations of the intestinal tract, this food may be imper- 
fectly acted upon, and undigested curds be discharged from the bowels. 
Their appearance has been noted in patients suffering from typhoid fever. 
In such cases the milk should be peptonized, or predigested. This is easily 
accomplished at a warm temperature by means of extracts for sale by all 
druggists. Five grains of the pancreatic extract and fifteen grains of 
bicarbonate of soda should be well stirred into a gill of water. After 
thoroughly mixing this with a pint of fresh milk, it should be bottled and 
allowed to stand in a warm place for an hour, and then kept on ice until 
required for use. The bitter flavor of peptonized milk is displeasing to 
many patients, and it is generally necessary to disguise the taste by adding 
a small quantity of coffee, or by uniting it with punches, gruels, etc., using 
it like ordinary milk. 

Xext to milk in frequency of use come beef-tea and other meat-decoc- 
tions. That these preparations in feeding the sick are comparatively use- 
less has already been stated. Beef-tea, and meat-liquids of a kindred 
nature, can properly be considered restorative and stimulant, but not 
nutritive. It is popularly supposed that in making them the nourishing 
qualities of the meat are extracted by the water, and that the dry, hard 
remnant of meat-fibre which remains undissolved is exhausted of its nutri- 
tive properties. This is almost always thrown away, and thus the most 
valuable constituents are sacrificed, and the liquid which is carefully pre- 
served contains so little in the way of sustenance it is almost worthless. 
The remnant actually contains nearly all the real virtue of the meat. If 
this be reduced to a paste by pounding in a mortar, and then added to the 
liquid in which it was cooked, beef-tea so prepared, and duly flavored with 
salt, is not only highly nourishing and agreeable, but also easy of digestion. 
The criticisms on beef-tea as commonly made apply equally to extracts of 
meat and meat-juices, and to similar preparations for sale by druggists; 
they are all devoid of the so-called albuminous constituents, the nutritious 
elements. 



MEAT-INFUSIONS, EGGS, AND GRUELS. 161 

Cold-made meat-infusions possess a very high nutritive value. The 
objection to them is their raw flavor, which to many is highly disagreeable. 
The unpleasant taste can, however, be disguised by adding ordinary beef- 
tea or the prepared extracts of meat; some patients prefer to have them 
made acid by a slice of lemon or a small quantity of claret. The bloody 
appearance of these infusions is quite likely to create an aversion, and, 
when made from beef or mutton', it is well to serve them in a red glass. 
When made from veal, the coloration is much paler, and meat off the breast 
of a chicken, being nearly white, yields a liquid extract which is almost 
colorless. In making cold infusions, the meat used should be minced and 
added to half its weight of water, allowed to stand for two hours, and then 
pressed through a cloth. It will be necessary to keep these liquids on ice, 
as they change quickly; or still better, to prepare them as needed, and 
serve at once. If administered warm, alone or added to beef-tea, they 
should not be heated above 114° Fahr. 

Raw eggs are among the most valuable resources in feeding the sick. 
They supply a liquid food which is not only highly nutritious, but also 
easily digestible. Few patients will care to attempt to swallow them 
whole, and by slowly stirring, to blend the white and the yolk, the dose is 
rendered less unpleasant. Eggs should never be beaten to a froth, as in 
that state they are indigestible, and invite flatulence and other dyspeptic 
symptoms. 

Of the so-called fortified gruels, Dr. William Roberts observes, although 
not precisely in the language which follows, that a very important kind of 
liquid food is furnished by gruels made with the several kinds of cereals 
or leguminous seeds. Gruels are not of themselves an agreeable kind of 
food ; they lack flavor. But mixed with milk or beef-tea, they constitute 
a valuable addition to our resources in feeding the seriously sick. When 
prepared from cereal flours in the usual way, they can only be made of a 
feeble nutritive power, if their liquid character is to be preserved. These 
flours are very rich in starch, and gruels made from them become thick and 
pasty if the proportion of flour used in their preparation rises to four or 
five per cent; a gruel of that strength contains very little of the more 
important elements. But if the meal be mixed beforehand with one- 
eighth of its weight of ground malt, gruels of a much higher nutritive 
value can be prepared from these flours, and still retain their liquid char- 
acter. The diastase of the malt acts upon the thickening starch as the 
heat rises, and converts it into soluble starch and dextrin. These fortified 
gruels can be made with as much as twenty per cent of meal and still 
retain the fluid state. Such gruels, being rich in constituents essential to 
nutrition, are admirably adapted, combined with milk or beef-tea, to supply 
a varied kind of liquid food, of highly nutritious character. Mixtures 
of this class seem especially suited for nourishment in cases of typhoid 
fever. 



162 DIETETIC TREATMENT OF THE SICK. 

The same eminent authority says: "If I wore asked to enumerate the 
ingredients and apparatus which are necessary for the cuisine of the sick- 
room and nursery, I think I could do so very briefly. In addition to the 
resources of the domestic kitchen and larder, the sick-room kitchen should 
contain a supply of the following Hours: oat, maize, malt, and lentil flours, 
in a finely pulverized condition and freed from bran. It should be pro- 
vided with a solution of soda-bicarbonate, of known strength. This would 
be of use to add to milk when necessary, and to assist in the preparation 
of peptonized articles of food. Next to these would come a reliable pan- 
creatic extract, and a preparation of pepsin or rennet for the production of 
whey. The associated apparatus should include a thermometer, wherewith 
the nurse could, when desirable, heat up cold meat-infusions to a proper 
temperature, and regulate the warmth required in the predigestion of food. 
A double-cased saucepan would form an indispensable item ; this makes an 
admirable hot-water bath for the preparation of beef-tea and fortified 
gruels. A pair of scales, glass measures, and a mincing-machine would 
complete the list. Finally, there should be, for the service of the nurse, a 
card or sheet containing plain directions for the preparation of the various 
kinds of liquid food. Given these simple appliances, I see no difficulty, in 
these days of skilled nursing, in the medical attendant being able to 
prescribe almost any kind of liquid food for his patients, in any combina- 
tion, and having it served up for the invalid in the most suitable possible 
manner." 

PREPARATION OF LIQUID FOODS. 

In the preparation of liquid foods for invalids, the following receipts 
will be of considerable assistance. They have long been sanctioned by the 
medical fraternity, and even the least experienced in the art of cooking- 
should be successful in their use. 

Beef-tea. Mince finely one pound of lean beef, and put it in a preserve- 
jar or other suitable vessel. Add to this one pint of cold water, stir well, 
and let the two stand for about an hour; after which set the jar into a 
kettle of cold water, over a slow fire, and allow it to boil gently for an 
hour. Remove the jar, and pour its contents on to a coarse strainer. This 
tea, after being duly flavored with salt and the quantity of sediment is 
well stirred in, has an agreeable, rich, meaty flavor, and is a highly 
restorative and stimulant liquid, possessing considerable nutritive value. 
It may be rendered still more nutritious by the addition of the meat 
remnant, which should be first made into a paste by powdering in a 
mortar. 

Chicken, veal, or mutton tea is prepared like beef-tea, substituting 
one of those meats. If broths instead of a tea are required, the articles 
should be boiled in a saucepan for two hours, and then strained. For 
chicken-broth the bones should be used as well as the flesh, and all chopped 



PREPARATION OF LIQUID FOODS. 163 

up. An old fowl will make a more nutritious broth than a young chicken; 
it should be boiled three hours. Pearl-barley, rice, vermicelli, or tapioca 
may be boiled with the meats, if desired, to give general nourishing power. 
Oatmeal, after being well cooked, may be added to beef-tea. One table- 
spoonful of the former should be mixed with two of boiling water, and 
then added to a cupful of strong beef-tea; this should then be brought to 
the boiling-point. 

Oyster-broth. Cut into small pieces a pint of oysters ; put them into 
half a pint of cold water, and allow them to simmer gently for ten minutes 
over a slow fire. Skim, strain, and duly flavor. 

Clam-broth. Take three large clams, and let them stand in boiling 
water until the shells begin to open. Drain out the liquor, add an equal 
quantity of boiling w T ater, a teaspoonful of finely pulverized cracker-crumbs, 
a little butter, and salt to suit the taste. 

In preparing gruels, if it is desirable to render them highly nutritious, 
the use of malt, as advised by Dr. Roberts, will be necessary. The fol- 
lowing receipts are for the ordinary compositions, in wdiich this agent is 
absent: — 

Oatmeal gruel. Mix thoroughly one tablespoonful of groats wdth two 
of cold water, and pour over them one pint of boiling water, stirring all 
the while. Boil for ten minutes, and still continue to stir. Sweeten with 
sugar, and add, if desired, a little sherry or brandy. Milk may be used if 
required, instead of w r ater. Another method of making oatmeal gruel is 
as follows : boil a tablespoonful of oatmeal in a pint of water, for three- 
quarters of an hour ; then put it through a strainer. If too thick, reduce 
with boiling water. Season with salt. Still another method is to add 
half a pint of oatmeal to a quart of water, and allow it to stand over 
night. In the morning add more water, if necessary, and boil for an hour. 
Squeeze through a fine strainer as much as possible, and blend it thor- 
oughly with a pint of boiling milk. Boil the mixture for five minutes, 
and salt to taste. 

Indian-meal gruel. Mix an even tablespoonful of Indian meal with a 
little cold water, and stir into a pint of boiling water. Boil for half an 
hour, and then strain, and season with salt or sugar, and add cream if 
desired. 

Arrowroot. Mix thoroughly two teaspoonfuls of arrowroot with three 
tablespoonfuls of cold water, and pour on to them half a pint of boiling 
water, stirring well during the time. If the arrowroot does not thicken, 
it should boil until that change takes place. This may be sweetened, and 
flavored with lemon-peel or nutmeg; sherry or brandy can be added, if 
required. Another method is to mix a teaspoonful of pure arrowroot with 
four of cold milk. Stir it slowly into half a pint of boiling milk, and 
allow it to simmer for five minutes, during which time it must be stirred 
constantly. Some prefer to flavor with half a teaspoonful of sugar, and a 



164 DIETETIC TREATMENT OF THE SICK. 

pinch of salt ; if desired, a small quantity of cinnamon, or half a teaspoon- 
ful of brandy may be added. 

Corn-starch or rice-flour gruel is made in the same way. 

Wine whey. Heat half a pint of milk to the boiling-point, and pour 
into it a wine-glass of sherry. Stir once round the edge, and as soon as 
the curd separates remove from the fire and strain. Simple milk whey is 
made by curdling warm milk with rennet, lemon-juice, or vinegar. After 
straining, the liquid forms a useful drink in febrile and inflammatory com- 
plaints. It is active in inducing perspiration, and increases the flow of 
urine. 

Treacle u*hey, or posset. Pour two or three tablespoonfuls of molasses 
into a pint of boiling milk, and afterwards let it boil up well, and strain. 
Drank hot, it is frequently used for a common cold. 

JShdlecl icine. Put two teaspoonfuls of broken stick-cinnamon and half 
a dozen whole cloves into half a cup of boiling water. Strain, after 
steeping ten minutes. Beat together until very light two eggs and tw r o 
tablespoonfuls of sugar, and stir into the spiced water. Pour into this, 
from a height, a cupful of sweet wine, boiling hot. This should be poured 
from one pitcher to another several times, to make it light and foamy, 
and served hot. The wine should not be boiled in a tin vessel. 

Eggnog. Beat the white of an egg well ; then stir into it in turn a 
tablespoonful of sugar, the yolk of an egg, a tablespoonful each of ice- 
water, milk, and wine. Simply stir lightly; do not beat. If it is desirable 
to make the eggnog stronger, the ice-w T ater need not be used, and brandy 
can be added. Hot eggnog is made with boiling milk. A little grated 
nutmeg improves the flavor. 

Barley-water. Wash two ounces of pearl-barley in cold water ; then 
boil for three minutes, and throw both waters away. Add two quarts of 
boiling water, and boil for about two hours, or until reduced to a quart, 
stirring frequently. Strain and sweeten, and for adults add the juice of a 
lemon. In preparing it for infants, the acid should be omitted. 

Toast-icater. Toast thoroughly, short of burning, three slices of stale 
bread, or, what is better, pieces of crust. Put into a pitcher, and pour 
over them a quart of boiling water. Cover closely, and stand it on ice 
until cold ; then strain. A little wine and sugar can be added, if desirable. 
A small piece of the peel of an orange or lemon, put into the pitcher with 
the toast, greatly improves the beverage. Toast-water is an excellent 
drink in diarrhoea, especially when nausea exists. 

Rice-water. Thoroughly wash one ounce of Carolina rice with cold 
water. Allow it to stand for three hours in a quart of water kept at a 
tepid heat, and afterwards boil slowly for an hour, and strain. This is a very 
useful drink in dysentery, diarrhoea, and irritated states of the stomach and 
intestines. When the conditions permit, it may be sweetened and flavored 
in the same way as barley-water. 



invalids' drinks. 165 

Gum-arabic drink. Dissolve an ounce of gum-arabic in a pint of 
boiling water; add two tablespoonfuls of sugar, a wine-glass of sherry, 
and the juice of a large lemon. Cover closely until cold, and thru strain. 
In preparing simple gum-arabic water, the sherry and acid are omitted. 

Flaxseed lemonade. Add to a pint of hot water two tablespoonfuls 
of sugar and three of whole flaxseed. Steep for an hour; then strain, and 
add the juice of a lemon and two tablespoonfuls of honey or sugar. Keep 
on ice until required for use. 

Linseed tea. Place one ounce of bruised flaxseed and two drachms of 
bruised licorice-root in a jug, and pour over them one pint of boiling- 
water. Lightly cover, and allow it to stand for three or four hours near 
a fire. Strain through linen, and, if desirable, add a very little sugar or 
lemon-juice. This constitutes an excellent drink in pulmonary or urinary 
troubles. It should not be given to patients who are taking lead, iron, or 
copper. 

Irish 7noss. Wash a handful of the moss in cold water, to remove the 
impurities. Then in fresh water allow it to remain until the water is near 
the boiling-point. This liquid will have extracted much of the bitter prin- 
ciple, and should be poured off. Next boil the moss with a pint of water 
for ten minutes, in a covered vessel, and strain with gentle pressure while 
hot. This may be flavored as desired. If an increased nourishing power 
is needed, milk may be used instead of water. 

Cream-of-tartar drink. To a quart of boiling water add a tablespoon- 
ful of cream of tartar, the juice of one lemon, and two tablespoonfuls of 
honey or sugar. Let it stand on ice until cold. This may be used freely 
as a drink; it is cooling, and increases the flow of urine. 

Lemonade. Pare the rind from a lemon thinly and cut the lemon into 
slices. Put the peel and sliced lemon into a jug with one ounce of white 
sugar, and pour over them one pint of boiling water. Cover the jug 
closely, and allow it to stand until cold; then strain and pour oft the 
liquid. 

Citron may be used instead of lemon, and likewise furnishes a pleasing 
and refreshing drink. 

Almond drink. Blanch two ounces of sweet almonds and four bitter 
almond seeds. Pound with a little orange-flower water into a paste, and 
rub this with a pint of milk, diluted with a pint of water, until it forms a 
milky solution. Strain, and sweeten with sugar. This is a pleasing drink 
in chest affections. It may be more quickly prepared with the " compound 
powder of almonds" (for sale by druggists), with a pint of water. 

The invalid's tea. Pour into a small china or earthenware teapot a cup 
of boiling water; empty it out, and while still hot and steaming put in the 
tea. Add enough boiling water to wet it thoroughly, and set it close to 
the fire to steam for five or six minutes. Then pour in from the kettle the 
quantity of boiling water required, and it is ready for use. 



166 DIETETIC TREATMENT OF THE SICK. 

Invalid's mashed potato. Boil one pound of potatoes with their 
jackets on till they are tender or brittle. Peel them, and rub them through 
a fine sieve; when cool, add a small teacupful of fresh cream, and a little 
salt. Beat lightly until quite smooth, and then warm for use. 

It is some years since Liebig announced to the medical profession his 
method of preparing infants' food, by using malt as an artificial digestive 
for starch. As the food is recommended as a nutritious drink for adults as 
well as children, and is well suited to invalids and convalescents, nurses 
should be familiar with its preparation. 

Dr. E. T. Williams says: "The commonest objection to Liebig's origi- 
nal formula is that it is too complicated. I consider this objection entirely 
frivolous. It is no more complicated than making bread or pastry, or any 
other of the common operations of cookery. I give here, in substance, 
Liebig's own directions, though I shall take the liberty of simplifying a 
little both the language and the process : — 

"Mix half an ounce of wheat flour with five ounces of milk in a sauce- 
pan, taking care not to lump it. Heat it to boiling, stirring carefully ; let it 
boil from three to four minutes, and remove from the fire. Now mix half 
an ounce of malt flour, one ounce of water, and seven and a quarter grains 
of bicarbonate of potash, and add it to the milk porridge, stirring steadily. 
This has the effect of thinning it out and making it sweet. Now cover up 
the vessel, and let it stand half an hour where it will keep warm but not 
boil. Finally, set it back on the fire, let it boil up once, and strain it 
through a fine hair-sieve, to remove the bran. The temperature at which 
the mixture should be kept after the addition of the malt should be about 
150° Fahr. Be sure that the porridge has entirely ceased boiling before the 
malt is added. The food when done should be quite thin and sweet. 

"It may be remembered, as Liebig remarks, to save the trouble of 
weighing, that a heaping tablespoonful of wheat flour weighs just about 
half an ounce. One-half of a heaping tablespoonful of malt flour weighs 
the same. The liquids may be measured in a tablespoon or wine-glass. 
The former contains one-half ounce, the latter two ounces of liquid. 
The potash should be put up in powders by the apothecary. Most 
cooks could ' pinch ' it up pretty accurately with the thumb and finger. 

"On the subject of malt Liebig's directions are as follows : — 

'"Barley malt can be readily bought of any brewer. ... A common 
coffee-mill answers for the preparation of the malt flour. It must be sep- 
arated from the bran by passing it through a coarse hair-sieve.' Such is 
the original formula, simplified a little from Liebig. In many cases it 
answers every purpose perfectly well. There is, however, one serious 
objection to it. The food sometimes loosens the bowels. Such is my own 
experience ; such is the general testimony of those who have used it. The 
trouble seems to be this: the coffee-mill grinds up too much bran, which 
gives a laxative quality to the food. I do not .know what sort of a mill 



liebig's formula for infant's food. 1<;7 

Liebig used, or what kind is most common in Germany, but the American 
mill (and I have tried this experiment many times) grinds husk and grain 
together, so that it is impossible to purify it effectually by sifting, thus 
rendering the food quite unfit for dyspeptic children, or those subject to a- 
loose or washy state of the bowels. Whoever will try the experiment of 
grinding malt in this way and examine the flour (no matter how carefully 
sifted) under the microscope, will find it quite full of angular pieces of 
husk, fully sufficient to explain its irritating action on the intestinal lining. 
I believe this to be the radical defect of the Liebig process, and the grand 
reason why the food has never come into more extended use. 

" I believe I have hit on a way to do this, in an improved method of 
preparing the malt flour. Instead of grinding the malt in a coffee-mill, I 
have adopted the plan of crushing or braying it with a mortar and pestle. 
This breaks up the kernel, but does not, unless carried too far, grind and 
tear the husk. It is highly important to use the pestle lightly, to put 
but a small quantity in the mortar at once, and not to pound or grind too 
long, as this breaks up the husk too much. The meal should then be 
'bolted,' or sifted through a fine wire or hair-sieve. This makes a fairly 
good imitation of the miller's way of grinding. The fine malt flour thus 
obtained should not exceed in bulk half the mass of separated husks and 
bran." 

The bicarbonate of potash is used in the preparation of the food to 
prevent its curdling on the stomach. In cases of diarrhoea, lime-water 
should be substituted, in the proportion of a tablespoonful, or more, if 
necessary, to six ounces of the food. 

The malt can be purchased of any grain-dealer. As it spoils very 
quickly, it should be bought only in the smallest quantities, and be closely 
kept in a glass-stoppered bottle or tin canister. Only enough for a few 
days' use should be ground at once. 



BOOK FOURTH. 



PRINCIPLES OF MEDICINE, 



CHAPTER I. 

SYMPTOMS OF DISEASE. 

That branch of the science of medicine which treats of the symptoms 
of disease is called symptomatology . The consideration of symptoms is of 
such great practical importance, it will occupy a large proportion of the 
space to be devoted to individual diseases. In this chapter will be dis- 
cussed the general manifestations of disease, the design being to familiar- 
ize the reader, by a preparatory course, as it were, with the symptoms 
commonly observed, and their probable significance. 

Before entering upon the study of morbid phenomena, it is first essen- 
tial to consider the expressive meaning of the terms health and disease. 
As one author says : " The definition of disease is confessedly difficult. It 
is easier to define it by negation, — to say what it is not than to give a 
positive definition, that is, a definition based either on the nature or 
essence of the thing defined, or on its distinctive attributes. Disease is an 
absence or deficiency of health ; but this is only a transfer of the difficulty, 
for the question at once arises, how is health to be defined? And to define 
health is not less difficult than to define disease." The most comprehen- 
sive definition of health is, "perfect circulation of pure blood in a sound 
organism." Any departure from these conditions constitutes disease. 

Nearly all deviations from health affect at once two of the most impor- 
tant vital processes, circulation and respiration, and alterations in tempera- 
ture accompany many, though not all, morbid states. Perfect circulation 
depends upon the integrity of the heart and its blood-vessels, and to learn 
the condition of that organ is the first important step in determining the 
existence of disease. The pulse is a valuable guide, as it varies with the 
condition of the heart, and affords an accurate index of its action. It is 
usually taken at the wrist, but if imperceptible there to the touch of one 
inexperienced, it may be felt in the neck, over the carotid artery. 

To accurately determine the pulse, two or three fingers should be 
lightly pressed along the course of the artery, and the beats counted for a 

16S 



PULSE, BREATHING, AND COUGH. 169 

full minute. The rate varies under different influences; age, sex, food, 
temperature, position, exertion, mental states, and many other conditions 
modify it, even in health. It is usually more rapid in women than in 
men, in children than in adults, and in short-statured people than in tall. 
It is slow during sleep, quickens after food is taken, is more rapid standing 
than sitting, sitting than lying down. 

The pulse in a healthy adult ranges from seventy to eighty-four beats 
per minute. Its character as well as frequency is subject to variations, and 
it is affected by nearly all abnormal conditions of the body. In some 
inflammatory affections the pulse is quick, full, bounding, and resists the 
compression ; in others it is hard, sharp, and contracted, vibrating like a 
cord under the finger. In prostration from diseases, in nervous affections 
and disorders of long continuance, also under the influence of fear, it is 
rapid, weak, and easily compressible. In apoplexy the pulse falls below 
the normal rate, often to fifty beats per minute, and is full and throbbing. 
In affections characterized by debility, it is soft and yields readily to pres- 
sure. In exhaustion the pulse is thin and thready, and as death approaches 
it becomes flickering. An intermittent pulse is often observed in nervous 
diseases, and has less significance than one irregular in character, which is 
usually indicative of serious disturbance. There are other departures. from 
the normal standard, but these already mentioned will suffice as illustra- 
tions of its variability. 

The processes of circulation and respiration are so intimately connected 
that the influences which modify the pulse also affect the breathing. The 
number of respirations per minute in a healthy adult is from eighteen to 
twenty, and the rate, as with the pulse, is varied by sex, age, stature, 
position, exertion, excitement, and many other conditions. Not only the 
frequency but the character is subject to variations, and among the terms 
in use expressive of the different modifications are regular and irregular, 
easy or labored, thoracic or abdominal, quiet and noisy, deep and shallow. 
Stertorous respiration is noisy, each breath being accompanied by a snoring 
sound. It is an evidence of profound insensibility, a symptom of narcotic 
poisoning, apoplexy and similar states of the brain. Dyspnoea is difficulty 
in breathing ; suffocation, or privation of breath, is termed apneea. Res- 
piration is said to be restrained or cautious when deep inspiration is 
attended with pain ; it is characteristic of pleurisy and fracture of the 
ribs. 

Cough is almost always associated with severe disturbances of the res- 
piratory organs, and its character will often suggest the disease which 
induces it. Thus a short, hacking, concentrated cough appears in the 
earlier stages of consumption, and grows hollow as the affection progresses. 
In croup the cough is sharp, and has a metallic or ringing sound. In 
asthma it is wheezing. In commencing acute bronchitis it is dry, painful, 
and often hoarse; it then changes as the disease progresses, and becomes 



170 SYMPTOMS OF DISEASE. 

moist and loss distressing. The matters expelled in coughing are called 
sputa. In the first stages of pulmonary diseases the expectoration is 
scanty, and as they decline it becomes copious. A greenish-colored 
mucous expectoration is characteristic of simple bronchitis, and the appear- 
ance of pus in quantities is observed in the later stages of inflammation of 
the lungs and in consumption. In chronic bronchitis and certain other 
pulmonary affections of long standing the sputa is yellowish, while in 
pneumonia it is rusty. In gangrene of the lungs the expectoration is dark 
greenish, copious, and extremely offensive. Spitting of blood occasionallv 
occurs in congestive diseases of the lungs, and may be caused by alcoholic 
excess, over-exertion, lifting heavy weights, running hard, etc. It is some- 
times a forerunner of consumption. Owing to modification in their char- 
acter, the eoughed-up matters cannot be considered as absolutely convinc- 
ing evidence of the existence of any particular disease. When viewed 
with other symptoms, however, they are of material assistance in reaching 
a positive diagnosis. 

The bodily temperature in health is about 93.6° Fahr., and the blood is 
the active agent by which this degree of heat is maintained. In growing 
youth the standard is one degree higher than in the adult. Xature, 
by a nice adjustment of the forces, has made provision to combat the exter- 
nal vicissitudes of heat and cold, and to preserve constantly a uniform 
internal temperature. Thus, on a very cold day the thinner and more 
exposed parts, such as the ears, the nose, and the ends of the fingers, may 
become cooled down considerably below the standard, and may even be 
congealed, if the cold be severe; but the temperature of the internal 
organs and of the blood still remains nearly the same under all ordinary 
conditions. At certain periods of the day there are, consonant with 
health, very slight deviations, possibly of one degree. According to the 
closest observers, the temperature of a healthy adult reaches its highest 
point in the evening, and lowest in the early morning. If, however, there 
is a rise of more than two degrees above the normal standard, and remis- 
sion does not soon follow, it may be regarded as indicative of disease. 
When the temperature rises to 105°, the so-called danger-line is reached. 
The same may be said when it falls to 96°. If the actual temperature of 
the blood becomes reduced more than five or six degrees below its natural 
standard, death inevitably results. 

Very many disorders of the system are accompanied by decided eleva- 
tions in temperature, and in some these changes are among the earliest, if 
not the first, symptoms manifested. In certain diseases, such as febricula, 
pneumonia, scarlet fever, and small-pox, the rise is rapid and sudden, while 
in typhus and typhoid fevers there is at first slight elevation, which gradu- 
ally increases. During the run of so-called continued fevers, the ordinary 
rule is that the temperature is lower in the morning and rises toward even- 
ing. To this, however, there are occasional exceptions, and the reverse is 



TEMPERATURE AND VARIATIONS. 171 

sometimes noted. During the course of those fevers which assume a reg- 
ular type, — that is, with nearly a uniform rise and fall of the temperature 
morning and evening, — any marked irregularity in the same is indicative 
of some complication. Or it may depend upon local causes, and be 
removed with them. Thus constipation will often cause a rise in tempera* 
ture, which will fall again after its relief. Mental excitement, impure air, 
external heat, stimulants, animal food, and a variety of other influences 
may have the same effect. In inflammatory affections, the extension of the 
existing disease, or the appearance of some other associate disorder, will 
send up the temperature. The formation of pus in any quantity is 
announced by the same variation. In typhoid fever, after the tempera- 
ture has become normal, a sudden rise of three or four degrees often 
occurs, and the change constitutes the relapse. 

Sufficient evidence has been given to show the diagnostic value of alter- 
ations in temperature. While any great modification is usually recogniza- 
ble to the touch, to measure it with certainty the clinical thermometer is 
indispensable. Those now commonly employed and by far the most con- 
venient are the self-registering. In preparing .the instrument, the top of 
the mercury should be made to fall several degrees below the normal. 
This can be effected by holding it in the fingers of the right hand, and 
striking the palm sharply on that of the left hand; several successive jars 
will be sufficient. 

The temperature may be taken under the' tongue, in the armpit or 
groin, or in the other cavities of the body. Before using the thermometer, 
a little time may be saved if the attendant holds it in her hand until it 
becomes warmed to the sub-normal degree. Excepting in children and in 
delirious patients, it will be easier to introduce it into the mouth, and the 
lips should be kept firmly closed during the process. The instrument 
should be left in place until the mercury has remained stationary for 
several minutes. In taking the axillary temperature, the axilla, or armpit, 
should be first dried from perspiration, and then the thermometer be held in 
position by pressing the arm closely to the side, the hand being drawn over 
to the opposite shoulder. It should be remembered that 98.6° is the normal 
axillary temperature; in the cavities of the body the mercury rises two 
deorees higher. 

Chills and rigors are nervous phenomena, and, although the patients 
are shivering, the temperature rises, because the vessels of the skin are 
so contracted the blood cannot reach the surface to be cooled. Chills, 
shown by pallor and coldness of the surface, often usher in acute diseases, 
and are always followed by high fever. Rigors are characterized by chat- 
tering of the teeth. They are common but not constant accompaniments 
of fevers, being more often seen in those affections in which the rise of 
temperature is sudden. The office of the perspiration is, principally, to 
regulate the temperature of the body, and on its appearance in fevers the 



172 SYMPTOMS OF DISEASE. 

unusual heat is generally materially lessened. There are, however, excep- 
tions to this rule, as profuse perspiration is often caused by extreme 

kness, by various nervous conditions, — such as anxiety, irritation, or 
ement. — and a variety of other influences. If a high temperature 

sts while the skin is moist, it is much more alarming than the same 
degree of heat with a dry surface. 

In determining the existence of a particular disease, aside from the 
facts to be acquired by a study of the pulse, respiration, and temperature, 
there are other signs of considerable diagnostic importance to be noted. 
In the attitude of a patient there are often valuable indications. Thus, if 
a lung be affected, the sufferer usually lies on the side diseased. In severe 
abdominal inflammations, and especially in peritonitis, the easiest position 
is d the back, with the knees drawn up ; while in colic the patient tinds 
greater relief lying face downwards. If a sitting position be persistently 
maiutained. then the disease is of the heart or lungs, and interferes with 
the breathing. In nearly all affections of the brain the position assumed 
ifi ithe back: slipping down in bed is also an associate symptom. In 
such rases, if the patient turns over to the side, it may be looked upon as 
a sign of improvement. Continued restlessness is indicative of danger, 
especially in organic diseases. Perfect quiet may be enforced, as in rheu- 
matism, for the reason that the least motion causes pain ; extreme weak- 
ness may render exertion impossible. Lying quietly is, however, usually 
a favorable sign. 

The expression is sometimes characteristic, and gives valuable indica- 
tions. Thus, a pinched and anxious look is a sign which often foreshadc ve 
evil, while a tranquil expression is of favorable import. In paralysis 
of the face the features are distorted, and the corner of the mouth is 
drawn toward the unaffected side. The eye also droops on the paralyzed 
side. If the face becomes expressionless, the danger is intensified. Some 
painful abdominal affections are accompanied by a sort of sardonic smile, 
from contraction of the muscles of the mouth. In children a red spot on 
one cheek is strong evidence of pneumonia, and the lung on the same side 
will be generally found inflamed. In apoplexy the cheeks fill out with 
each expiration. In typhoid fever the lips are cracked and sore, and an 
almost pathognomonic symptom in pneumonia is an eruption about the 
mouth, called herpes labiaiis. If a child cries, as if with pain in the head, 
and tears do not come, then serious trouble may be suspected ; but if tears 
do show, it is an evidence of a functional disturbance. Swelling of the 
eyelids indicates kidney trouble. Intolerance of light is a symptom of an 
irritability of the brain. In meningitis, pneumonia, and certain other 
diseases, the eyes are brilliant ; in the so-called Graves' disease they are 
markedly prominent. Loss of sight often indicates disease of the brain. 
In tubercular meningitis the eyes are widely dilated, and the same condi- 
tion of the pupils results from the use of belladonna. Opium causes the 



INDICATIONS AFFORDED BY THE TONGUE. 173 

pupils to contract; after large closes of santonine have been taken, the 
sight is so changed tilings look yellow. In paralysis of one side the 
patient cannot close the eye on the affected side. Dilatation of the nostrils 
indicates difficulty in breathing, and points to the lungs. In fact, every 
change in the features is noteworthy, and of diagnostic importance. 

The sense of hearing is preternaturally acute in some conditions, and 
often precedes delirium. Defective hearing may be due to local congestion, 
to disease of the brain, or to the use of drugs, more especially quinine. 
The appearance of the teeth is of no little importance. While in con- 
sumption they are unaffected by that disease, in many other constitutional 
disorders characterized by disturbed nutrition they rapidly decay. Saliva- 
tion sometimes appears in scurvy, and is also caused by the excessive use 
of mercury. A blue line forms on the gums in lead-poisoning. Taste is 
often impaired or vitiated. With disordered liver there is often a bitter 
taste ; consumptives complain of one salty. The use of certain drugs 
induces a decided metallic, or, as it is often described, a coppery taste. 
This sense may be entirely absent for a time. 

Aphonia is loss of voice. It is incidental to a variety of diseases of 
that part of the throat called the larynx; it may be purely a functional 
affection, known as nervous aphonia, and it is often due to paralysis of the 
nerve which controls the movements of the vocal cords. Aphasia is the 
loss of ' speech or power of expression bywords or letters, and proceeds 
from disease of the brain. Aphasia may be complete or partial, the 
patient in some instances being absolutely dumb, in others limited to a few 
words. A difficulty in speech may consist in an inability to express the 
mental ideas by a proper selection of words. Things are not called by 
their right names, and the language in sentences, either spoken or written, 
is unintelligible. Hiccoujh, ordinarily of little account, is an important 
and unfavorable symptom toward the close of acute diseases. 

The tongue offers many valuable indications, for it indexes not only the 
state of the digestive organs, but, to some extent, the condition of the 
Avhole system. In health it is moist. A pasty, white coating is seen in indi- 
gestion. Sub-acute intestinal or stomach troubles change the natural color 
to white or light brown. A dark brown or black tongue is seen in typhoid ; 
also in surgical diseases, when the patient is dying from prostration. 
In cancer of the stomach, also in chronic inflammations of that organ, the 
tongue is usually white. In acute diseases the whole surface is covered, 
while in chronic affections the coating is seen in spots. In scarlet fever 
there is often a characteristic appearance known as the "strawberry- 
tongue." The tip is never coated unless other parts are similarly affected. 
Clearing of the coat in disease is generally a favorable sign, although in 
typhoid it is not uncommon to see the tongue clear up several times during 
the course of the disorder. The process of removal is usually gradual, the 
deposit wearing off. In cases of insanity due to general paralysis, tremor 



174 SYMPTOMS OF DISEASE. 

of the tongue is considered an important diagnostic sign. In advanced 
stages of typhoid it is tremulous, and if the patient does not draw it back 
it is an evidence of great nervous prostration. In the same disease the 
tongue is often dry, cracked, and bleeding, and constitutes a very unfavor- 
able sign. In hemiplegia it points to the paralyzed side. The existence of 
scars suggests epilepsy, as m that disease it is often bitten. While a clean, 
moist tongue is generally an evidence of good health, there are exceptions 
to this rule, and occasionally in patients in poor condition no abnormal 
appearance in this member is noted. 

Simple sore throat is a common affection, and an examination reveals a 
reddened mucous membrane, and possibly some swelling. Dirtv white 
patches are seen in diphtheria; in tonsillitis the parts are swollen. In the 
former disease there is usually less difficulty and pain in swallowing than 
in the latter. Swallowing may be interfered with by foreign bodies in 
the throat, cancer, pressure by tumors in the neck, by paralysis, diseases of 
the brain, hydrophobia, and a variety of other causes. It is not uncommon 
for nervous people to imagine that they have stricture of the passage into 
the stomach. 

The appearance of the skin is very often instructive; any deviation 
from health is easily detected. A yellowish tinge is indicative of a dis- 
ordered action of the liver. Pallor is a suspicious sign, unless caused by 
fright, or other great mental excitement. Blue curtains and uncertain 
light often cause a ghastly appearance. In such cases the guide should be 
the lips. In disturbed circulation there is often a slightly bluish shade. 
With anaemia there is a peculiar paleness; in Bright's disease a creamy, 
waxy complexion. Bluish black spots, appearing in the course of severe 
affections, such as diphtheria or scarlet fever, are ominous as indicating a 
hemorrhagic tendency. The diagnosis of eruptive diseases cannot be con- 
firmed without the characteristic efflorescence. 

In nearly all acute diseases a loss of appetite is occasioned ; in hysteria, 
insanity, and sometimes in dyspepsia, the reverse is noted, and the demand 
for food is increased. In certain conditions the appetite becomes perverted, 
and there exists a longing for unwholesome substances. After many dis- 
eases, a desire for food is one of the earliest symptoms of convalescence. 
Thirst is almost always present in acute, seldom in chronic diseases. It 
is, possibly, more intense in severe inflammations of the stomach and intes- 
tines. It is absent in diseases of the brain. 

A common symptom is nausea. Vomiting occurs in many functional 
diseases, in affections of the brain, and especially in disorders of the abdom- 
inal organs. In peritonitis it is persistent, and the matters vomited are 
largely made up of bile. In this affection the food is carried on down the 
intestine, but when the bile pours out it is drawn up into the stomach 
and ejected. Vomiting is almost always present in hepatic and renal colic, 
particularly in the former. In Asiatic cholera, and in the third tage of 



EXCIIEMENTAL DISCHARGES. 175 

Bright's disease, it is rarely, if ever, absent; in chronic intestinal disorders 
it is prominent as an early symptom. It also appears in the initial stage 
of certain eruptive diseases, among them scarlet fever and small-pox. 
Vomiting is induced by a variety of other influences. It follows prolonged 
fits of coughing, sudden or severe attacks of pain, sight of disgusting 
objects, sense of horror, surgical operations, overwork, anxiety, and over- 
care. If fecal matter is vomited, it is an evidence of strangulated hernia, 
or intussusception. Pain in the stomach and vomiting continually occurring 
after eating are symptoms of gastric ulcer. If the attendant pain is con- 
stant, lasting for weeks, and is confined to the region of the stomach, 
malignant disease may be suspected. In ulcer of that portion of the intes- 
tine termed the duodenum, pain is a symptom, and is felt at the pit of the 
stomach; but vomiting is not present, or is only occasional. Blood is 
sometimes ejected from the stomach, and usually has the appearance of 
coffee-grounds. In very many cases of hemorrhage from the lungs, the 
patients refuse to be convinced of the true source of the bleeding, and 
obstinately maintain that it came from the stomach. When blood in any 
quantity is found in the vomited matter, it is usually present also in the 
intestinal discharges, giving them a dark color and a tarry consistence. 
Certain drugs, such as iron and bismuth, blacken the discharges. 

Information of much diagnostic importance can be acquired by noting 
the frequency, quantity, and appearance of the evacuations. Constipation 
is attributable to a variety of causes. It is a symptom of lead-poisoning, 
tubercular meningitis, and many other affections, and is common in dys- 
peptics, in women, and people of sedentary habits, and in those who live on 
highly nutritious food. Peritonitis often begins with a slight diarrhoea, 
but soon the bowels become constipated. In insufficient secretion of bile, 
constipation is an associate symptom with jaundice, the stools being clay- 
colored. Certain drugs, among them opium, induce the disorder. Per- 
sistent and unyielding constipation is present in intestinal obstruction. 
Diarrhoea is characterized by loose and' frequent evacuations. In occa- 
sional cases it exists with constipation, hardened masses having accumulated 
in the bowel. Diarrhoea owes its origin to inflammations and, sometimes, 
ulcerations of the intestinal canal, to exposure, improper food, poisons 
taken and those formed in the system, to fright, or any strong emotion. 
When it appears in typhoid and other prostrating diseases, and the evacu- 
ations are involuntary, it is a symptom of gravity. In convalescence from 
those affections, diarrhoea has not the same significance. 

The discharges in diarrhoea may be clear, like water, staining but 
slightly, and comparatively odorless. Such are noted in cholera infantum 
and Asiatic cholera; in the latter, small flakes are often seen. Blood is 
occasionally evacuated. It may come from the lungs, having been swal- 
lowed, or any part below the stomach. Hemorrhage from the bowels in 
typhoid is a grave but not necessarily a fatal symptom. In hemorrhoids 



176 SYMPTOMS OF DISEASE. 

the discharge is of blood, but slightly, if any. changed in appearance. The 
higher up its source, the darker-colored and more tarry it becomes. 
Malignant and fungoid growths may also be the cause of bleeding from 
the bowels. In cancer of the rectum it is sometimes the first symptom of 
the disease. If blood is evacuated, and with it pus is intermingled, it is 
evidence of the opening of an abscess internally. Thus it will be seen 
that the inspection of the discharges in diseased states is important. In 
dysentery the evacuations are small at first ; they are mucous, of jelly-like 
appearance, possibly tinged with blood, and accompanied by severe strain- 
ing. In dyspeptic patients the feces are hard and round ; they are ribbon- 
like in stricture of the bowel from growths, enlarged prostate, and other 
causes inducing pressure. The discharges are extremely fetid in disordered 
states of the liver, in ulcerative inflammations of the intestinal lining, in 
consumption ; also after taking certain kinds of food and medicines. 

The urine in disease has certain changed characteristics, a knowledge 
of which is important. In cirrhosis of the liver and in Bright's disease of 
the kidney it is scanty. Frequent desire to empty the bladder suggests an 
inflammation of that organ or the passage from it ; it may be due to 
the pressure of a misplaced uterus. Dribbling sometimes exists when the 
bladder is full. The terms in use referable to urinary derangements are 
incontinence (inability to retain), retention (inability to pass after secre- 
tion), suppression (non-secretion). The last mentioned is due to morbid 
states of the kidney. Retention of urine may be due to intense nervous 
excitement, or to a closure of the emptying passage. In strangury the 
urine passes in drops, and is attended with an intense burning pain. This 
disturbance is sometimes due to large burns ; also to the internal use of 
certain medicines, among them can th arid es and turpentine. The odor of 
urine is fetid in prostatic disease, while in diabetes mellitus it is fragrant, 
and resembles that of new-mown hay. When the urine contains blood the 
odor is offensive. It is also influenced by certain vegetable foods; among 
them asparagus is conspicuous. The odor of eubebs, copaiba, and sandal- 
wood oil is promptly communicated to the urine of persons taking them; 
after the use of turpentine, it is strong of violets. In slow poisoning by 
carbolic acid the urine is smoky ; in disordered states of the liver it is high- 
colored; and in severe jaundice it leaves on linen a yellow stain. In acute 
fevers and inflammatory affections the quantity of urine is less than normal, 
while it increases in convalescence. There is also an increase in hysterical 
and convulsive conditions, and in diabetes this is markedly so. A reddish 
sediment thrown down on standing is not, as many suppose, always an 
evidence of kidney disorder, but is more often due to liver derange- 
ments. 

The general appearance of the body is indicative of the state of nutri- 
tion. In nearly all diseases fat is lost, and emaciation results. In affections 
of the digestive organs the reduction in weight, if present, is slow, while 



DIABETES AND DROPSY. 177 

in diabetes the waste is rapid. In malignant diseases there is a general 
lowering of all the vital forces, which explains the speedily progressive 
emaciation. In some forms of insanity, notwithstanding an increase in 
appetite, loss of weight is often marked. An increase in size in certain 
parts of the body, attended with general emaciation, is a sign of defective 
nutrition. An enlargement of the glands in the neck and abdomen is an 
evidence of constitutional impairment. 

(Edema, or dropsy, can almost always be attributed to the heart, kidney, 
or liver. In diseases of the heart the swelling begins in the lower extremi- 
ties. In diseases of the liver the abdominal cavity is usually first filled, 
while if the dropsy is due to an affection of the kidneys, it appears in the 
face, nose, and eyes, and afterwards extends over the body. In dropsy the 
swollen tissues pit like dough on pressure. In vitiated states of the con- 
stitution the hands and feet sometimes swell ; the enlargement is, however, 
but slight. 

In the foregoing many of the most common symptoms appearing in 
disease, with their usual significance, have been mentioned. Compared to 
the possible manifestations, however, they represent but a small proportion. 
A disease is rarely, if ever, twice ushered in with identically the same 
symptoms, or runs its course with unvarying phenomena. This fact must 
be appreciated by the reader, who might, without a knowledge of it, antici- 
pate finding in each case all the signs typical of the existing affection. 



CHAPTER II. 
CAUSES OF DISEASE. 

Knowledge of the causes of disease is not only essential as the basis of 
prevention, but in many instances it is also important in effecting recovery. 
If the exciting agencies are known, their morbific influence can, in a great 
measure, be obstructed. After inducing disease the cause not infrequently 
continues operative, and its removal is necessary before treatment can be 
successful. The essential causes and ultimate nature of many diseased 
conditions have been discovered, but progress is slow, and there yet 
remains laborious and continued searching. A growing understanding, an 
accumulation of facts and individual experiences, are materials from which, 
at some future period, will be developed truer perception and a more 
accurate knowledge of the causal connections of disease, and their con- 
formity with fixed laws. 

As generally defined, causes are intrinsic, or internal, and extrinsic, or 
external. As the names imply, the external causes are those which act 
upon the body from without, and among them are infections, miasms, con- 
tagious matters, the different poisons ; also wounds, injuries, and all poison- 
ous influences which exist independent of the human organism, yet are 
active agencies in inducing disease. On the other hand, the internal or 
intrinsic causes are developed within the animal economy, and owe their 
origin to impairment of certain vital processes. Of the exact nature of 
many of these causes but little is known ; what changes are essential or 
determining, and what especial influence is dependent, subordinate, or 
accidental, is yet largely limited to inferences. When the kidneys act 
imperfectly, urea, a poisonous constituent of the urine, is retained in the 
blood, and disease is manifested. The agencies which induce gout, rheuma- 
tism, and many other affections are generated within the body, and are 
examples of the intrinsic or internal causes. The intimate relation which 
exists between the mind and body has already been dwelt upon in the 
chapter devoted to " Mental Hygiene." Among the internal causes belong 
those termed mental or emotional, and they play an important part in the 
production of disease. 

178 



EXPLANATION OF TERMS. 179 

Causes have been distinguished as ordinary, and special or specific. 
Ordinary causes are those to which all persons are more or less exposed, 
and each giving rise to certain forms of disease. They may also be termed 
unavoidable, and include heredity, age, sex, and, practically, climate and 
occupation. Special or specific causes are those which are infrequently 
encountered, and each cause gives rise invariably to one form of disease 
There is no satisfactory evidence that any of these causes ever arise spon- 
taneously ; in every case the pre-existence of the specific poison or organ- 
ism is necessary. Cholera, yellow fever, typhus, small-pox, etc., illus- 
trate the diseases which are produced by special or specific causes. 
In fact, that the cause of a disease is specific is to be inferred if the disease 
transmitted is always the same disease. Thus the cause of small-pox is 
always the same, and it can give rise to that disease alone. The same law 
is fixed for other diseases which owe their origin to a specific germ or 
poison. 

Infections diseases are those affections which are known, or at least 
believed, to originate through the infection of the system with certain pecu- 
liar poisonous matters, and which are mainly distinguished from ordinary 
poisons by the fact that they can reproduce themselves under favorable con- 
ditions to an unlimited extent. The peculiarity of this class of diseases is 
their specificness, which is evident in the fact that a given kind of disease is 
solely due to a given kind of morbid agent or cause. In this respect they 
are essentially different from those diseases propagated by ordinary causes. 
Of the latter class exposure to cold is an illustration, and that occasions 
different affections in different individuals. Thus, in one person it gives 
rise to bronchitis, in another to colic or diarrhoea. On the other hand, 
infection from a patient with small-pox produces that disease, and never 
any other affection. 

Infectious diseases are divided into miasmatic and contagious. Miasm, 
in its original and broadest sense, is the name for any material con- 
tained in the air that can produce disease. The term is now used m 
a far narrower sense, and in contradistinction with the term contagion. 
According to Liebermeister, contagion is a specific excitant of disease 
which originates in the organism suffering from the specific disease; 
while miasm, on the other hand, is used to designate a specific excitant 
of disease which propagates itself outside of and disconnected from a 
previously diseased organism. Contagion can be conveyed by contact 
from a diseased person to a sound one, produce the disease in him, 
and then reproduce it. Miasm originates from without; taken up into 
the body, it can call a specific disease into action, but it cannot spread 
the disease any further by conveying it from a diseased to a sound person. 
Malarial diseases are purely miasmatic, while measles, scarlet fever, and 
diphtheria are examples of the purely contagious. To the latter class 
belong also glanders and rabies, diseases which are derived respectively 



LTJSES OF DISEASE. 

from the horse and dog, and which may be reproduced in man 
the introduction into his system of the causative element, called the 

. 

Disease-poisons are termed volatile sndjixed. The distinction lies in 
the fact that some of them can be conveyed to the human body by means 

the air. while in others such a transmission does not >eem to take place. 
A- an illustration, vaccination is produced by conveying a palpable product, 
a virus, from one parson affected with vaccinia to a sound person. In such 
an instance the poison is fixed. On the other hand, from the body of a 
person having small-pox, or contagious disease of a kindred nature, there 
are impalpable emanations which are capable of reproducing similar dis- 
ses in others. In this instance the poison is volatile. 

There is a class of diseases which originate in a miasm, and yet they 
can be communicated from an infected to a sound person. By reason of 
these combined characteristics they have been denominated mi 

- Ust ses. This term is also used by some writers for those dis- 
eases which, as is supposed, require a causative agent produced within the 
bodies of persons affected, but an agent which it is requisite should undergo 
certain changes after haA'ing been thrown off from the body before becoming 
capable of giving rise to disease in others. Epidemic cholera is one of the 
diseases which is thus distinguished, the poison being communicated by 
the intestinal discharges of a person so affected. 

Certain causes are distinguished as traumatic, and the affections pro- 
duced by them are termed traumatic diseases. Anything which occasions 
an injury or wound of a part, and consequently disease of that part, is a 
traumatic cause. As an example, if a blow upon the head induces inflam- 
mation within the skull, the cause is traumatic. In this instance it is 
external; but in inflammation of the bladder induced by a calculus, then 
the traumatic cause is internal. 

There are certain diseases which are designated spontaneous. The use 
of the term is of doubtful propriety, for, while these diseases are developed 
without appreciable causative agency, there is as little evidence of spon- 
taneous generation. As has been aptly said, the number of so-called spon- 
taneous diseases will diminish in proportion as the knowledge of etiology 
advances. Even now, in connection with disease, spontaneous ge 
is synonymous with unknown general 

Causes are distinguished as primary and secondary. The secondary 
cause is an effect of disease which a primary cause has brought into 
existence. The same distinction is made among diseases. Primary dis- 
eases are induced by primary causes, and those called secondary owe their 
origin to the pre-existing diseases — in other words, to secondary causes. 
They are developed in the course of the primary affections, with which 
they are supposed to have some pathological connection. A Jis >:- is 
said to be intercurrent when it occurs during the progress of another dis- 



DIAGNOSIS. 181 

ease, accidentally as it were, without necessarily having any dependence 
upon it. 

Causes are distinguished as predisposing and exciting. While the 
former are influential in increasing the susceptibility to disease, the kind 
of the disease and its occurrence are determined by the latter causes. In 
many diseases the predisposing causes play a more exciting part than the 
exciting causes. Various circumstances may act as co-operating or acces- 
sory causes, that is, in conjunction with the predisposing causes or 
tendency. The term vulnerability is used in contradistinction to predis- 
position. While the latter denotes a tendency to a particular form of 
disease, the former is expressive of a general susceptibility to all morbific 
influences. 

Diseases are said to be endemic when they are limited to a certain terri- 
torial district. They are called epidemic when they occur at intervals and 
then disappear, prevailing successively or simultaneously in different and 
widespread territorial regions. Diseases are said to be pandemic when 
they spread simultaneously over a whole community. Certain diseases are 
transmitted by means of clothing and other inanimate substances to which 
the contagious matter has adhered. These are called fomites. In this 
connection the term portable is applied to diseases the germs of which are 
capable of transportation. 



DIAGNOSIS. 

The term diagnosis means the discrimination of diseases, that is, deter- 
mining their character and situation. It is sufficiently obvious that treat- 
ment cannot be successfully employed until the nature and seat of the 
affection are ascertained. It is properly said that diagnosis involves more 
embarrassment than the management of diseases. A symptom is diagnos- 
tic when it occurs more frequently in connection with a particular disease 
than with other diseases. Symptoms are of a variable significance. Some 
uniformly denote the existence of a particular disease, as they occur only 
in connection with that one affection. These symptoms are distinguished 
as pathognomonic. As an illustration, a rusty-colored, semi-transparent, 
and adhesive matter of expectoration belongs exclusively to pneumonia, 
and is therefore a pathognomonic symptom, always denoting the existence 
of that disease. Some symptoms are said to be highly diagnostic, as, while 
not conclusive evidence of particular diseases, they point strongly to their 
existence. Other symptoms are moderately, and, again, others are merely 
slightly, diagnostic. 

There are very few diseases indeed which give rise to pathognomonic 
symptoms; were the number measurably increased, the discrimination of 
diseases would be proportionately less difficult. Symptoms are objective or 
subjective. The subjective symptoms are those which relate to the sensa- 



182 CAUSES OF DISEASE. 

Uons and toolings of the patient, and much of their diagnostic value 
depends upon clear description and truthful representation. In young 
children this class oi symptoms is not available. The objective symptoms 
are those appreciable to an observer. 

In some instances a diagnosis is difficult. All the symptoms typical of 
a disease are but rarely present : some are often absent, others unduly 
prominent, and occasionally there appear unusual symptoms to embarrass 
the investigator. Each case must be carefully studied, and an opinion 
should not be based on individual symptoms alone, but all should be duly 

ghed, and conclusions drawn from them as a whole. A knowledge 
of the laws of disease is often important in relation to diagnosis. It 
is a peculiarity belonging to certain disorders, especially those of an 
infectious character, that a single attack of the disease, successfully sur- 
mounted, bestows an absolute or relative immunity from it for a certain 
time, or even for the remainder of life. This is especially true of measles, 
small-pox, vaccinia, typhus, or yellow fever. Persons over fifty years of 
_ are rarely affected with typhoid fever. Consumption seldom attacks 
patients suffering from asthma. Similar illustrations might be multiplied, 
but in the consideration of individual diseases the important facts bearing 
upon this subject will be fully discussed. 

In reaching the diagnosis of a disease, the previous history is essential ; 
a knowledge of the duration of the symptoms will materially assist in 
determining whether it is of an acute or chronic character. It may be 
inferred that the disease is acute if the patient was but recently in the 
enjoyment of good health, and the attack is more or less sudden in its 
invasion. If, on the other hand, the symptoms manifested are but intensi- 
fied forms of those previously existing, it is probable that the disease is 
chronic and of long continuance. 

The reader will doubtless meet cases in which it will be impossible for 
him to reach a correct diagnosis. It is not reasonable to suppose that in 
any one work, even in the most exhaustive treatise, can be embodied all 
the principles of medicine and teachings necessary to qualify a member of 
the laity a skilled diagnostician. Even physicians of the highest practical 
endowments often err in their attempt to discriminate diseases, and the 
fact that diagnosis involves more embarrassment than the treatment of 
se should be appreciated by all. 



PROGNOSIS. 

A judgment of the course and termination of disease by its symptoms 
is called prognosis. This is an important division of medicine, as a correct 
estimate of the course a disease will take is measurably influential on the 
treatment. The symptoms of disease are not alone to be depended upon; 
there are also other circumstances which it is essential to consider in reach- 



SIGNS OF IMPENDING DEATH. 183 

in<>- :i prognosis. Some people are less able to sustain and overcome 
disease than others, and recovery might take place in one instance, 
while in another a disease equal in all respects might prove fatal. All 
the circumstances connected with diseases upon which a prognosis is 
based are termed prognostic. In predicting the course ot" a disease, 
ail the symptoms present should be carefully weighed, as often one, 
which alone would be insignificant, becomes, in its relation with others, 
of grave importance. A clear understanding of the complications which 
may arise in the course of a disease is also important in reaching a 
prognosis. 

It is obvious that known habits of intemperance would unfavorably 
influence the prognosis in pneumonia and other severe affections. The 
weather is an important factor; severe winters tell sorely on the aged, and 
many acute diseases yield but slowly to treatment during inclement seasons. 
Pneumonia, occurring as a complication of typhoid fever, is but rarely recov- 
ered from. Swelling of the legs in cases of consumption is an evidence that 
the end is near. Restlessness in a person who has suffered severe hemor- 
rhage is an unfavorable symptom ; so also is sighing, in cases of exhaus- 
tion. If a patient remains long immovable, or slides down in bed, the 
condition is a grave one. The same may be said if, in exhaustive fevers, the 
sufferer is disposed to continuous movement, such as picking at the bed- 
clothes. Notable emaciation and pallor are not important in acute diseases, 
but in any chronic affection they are unfavorable prognostics. Emaciation 
alone, when the cause cannot be determined, is a very discouraging 
symptom. Dropsy of the extremities, when appearing in acute diseases, 
has less significance, but in chronic affections it indicates danger. Dropsy 
of the face is an important sign of kidney disease. The expression, if 
changed in an acute affection, foretells evil results. Complete insensibility, 
which does not terminate within twenty-four hours, may be regarded as 
almost certainly fatal. If, in severe organic diseases, the pain which has 
been continuous suddenly ceases without the intervention of narcotics, 
the approach of death is generally indicated. Great frequency and feeble- 
ness of the pulse, exclusive of diseases of the heart, and especially in acute 
affections, point to a fatal termination. Great prostration, incoherence of 
speech, muttering, slowness of comprehension, apathy, unusual irritability 
of temper, difficulty in swallowing, and a tendency to spill food, are all 
symptoms of gravity. 

Among the obvious symptoms of impending death are involuntary 
evacuations, inability to swallow, and lividity of the lips and face. To 
these may be added notable increase in the temperature of the body, if 
persistent. Death approaches through one of the three vital organs, the 
heart, lungs, or brain ; the first to falter in its action governs the train of 
symptoms which follow. Among the signs of a dying state are coldness 
of the extremities, restlessness, a certain sharpness of the features, a pinch- 



]£4 CAUSES 

ms of the noe i, lufi shade about the face, sinking of the e : 

in t]ie th , . raegsol the temples, coldness and transparency 

i iration, dropping of the lower jaw, the flesh nn 
the nails of a purplish tint. a muscular twitching, and stupor. 

> the vital force departs, > not painful even though intense 
_ may hav 1 it. 






CHAPTER III. 
MEDICINES AND THEIR ADMINISTRATION. 

A perfect familiarity with the properties of medicines, the diseases to 
which they are respectively applicable, and their adaptation to the peculiari- 
ties of individual patients, can only be acquired by years of patient study. 
The thoroughly educated physician alone attains this clear and certain 
understanding of the use of remedial agents, as it is not a science distinct 
in itself, but is blended and inseparable from other principles no less 
important to the healing art. An exhaustive dissertation on the physiolog- 
ical actions of drugs would therefore be purposeless, and possibly defeat 
the object of the author, who studies simplicity and a careful avoidance of all 
subjects which cannot be deemed essential in this work, and the discussion 
of which would but confuse the reader. In the consideration of individual 
diseases the treatment of each will be clearly defined, and a list of the 
drugs in common use, and their doses, will elsewhere be given. In this 
chapter a few general and precautionary rules on the administration of 
medicines will be appropriate. 

Medicines may be introduced into the system through the skin, the 
mucous membrane, and the subcutaneous tissue. Medicinal agents when 
simply placed in contact with the skin are but indifferently absorbed. 
The process is hastened if friction is employed, and is much more rapid if 
the cuticle is removed by blistering. The introduction of medicines by 
means of raw surfaces was formerly practised extensively, but at this 
period it is rarely resorted to. The fact of more ready absorption when the 
skin is broken should be remembered in using medicated plasters contain- 
ing agents such as belladonna and other narcotics. Subcutaneous or 
hypodermic injections are administered to relieve pain or induce sleep, and 
when the speedy action of a drug is important. This form of medication 
has been growing in popular favor, and very many of the remedial agents 
in common use are now concentrated by the chemist's art, and conveniently 
prepared for hypodermic injection. Medicines introduced in this way, act 
more powerfully and more rapidly than in any other way, and the pain 
caused by the operation is but trifling. The dose of a drug which it would 
be proper to take by the stomach should be lessened one-half when given 

185 



- AND THElli ADMINISTRATION. 

snbcutaneously. It is almost needless to add that the hypodermic syringe 

is an instrument the use of which should be restricted to physicians, as in 
the hands of the incompetent it is dangerous in the extremest s 

- itutional as well as local effects may be obtained from 

inhalation. In this way insensibility is induced by chloroform, ether, and 

nitr - gas. Aside from these agents there are but few similarly em- 

. accept through an atomizer, in the form of spray. This method of 

nient is I _ n fined to diseases of the throat, although occasionally 

- used in affections of the lungs. There are occasional cases in which 
the inhalation of steam is advisable. A simple and convenient device for 
the j se is a pitcher of hot water having closely fitting over it a cone 

of thick paper, with an opening at the top, through which the patient may 
breathe. He should inhale by the mouth, and exhale through the nose. It 
can be made medicinal by the addition of drugs to the hot water. 

The most common mode of introducing medicines into the system is 
through the mucous membrane, generally that of the stomach. They are 
taken in the solid state, as in the form of powder, pill, troche, wafers, cap- 
l nary : in the form of mixture, in which a solid is suspended in 
a Ik; ::e liquid is mechanically mixed with another, in which it is 

insoluble : or in a state of solution, under which may be included the 
various forms of decoction, infusion, wine, syrup, etc. The form in which 
drugs are administered is often an object of considerable importance. By 
variation in this respect, according to the nature of the medicine, the taste 
of the patient, or the condition of the stomach, a more favorable operation 
of remedies is >ften secured. 

F : r medical purposes very many drugs in common use are employed in 
the form of extracts. These contain much of the active principles of the 
subsl 3 £ :m which they are obtained, very much of the inert matter 

being removed in the process of evaporation. By this mode of concentra- 
tion a larcje proportion of the remedial agents can be given as pills, of a 
size convenient for swallowing. This form is well adapted for the adminis- 
tration of medicines which are unpleasant to the taste or smell, or are in- 
soluble in water. "Wlien large doses are required, and the agents used are 
of objectionable flavor, they are frequently inclosed in wafers of rice-paper 
or doucrh, or in capsules of gelatine, either of which will dissolve readily 
and liberate its contents in the stomach. Occasionally are met patients 
who find an almost insuperable difficulty in taking pills. The smaller the 
pill, the harder it is to swallow ; if its size is increased by enveloping it in 
bread or jelly, the trouble will often be overcome. It should be placed as 
far back in the throat as ssible, and followed immediately with large 
swallows of water. 

ire small, dry. solid masses, usually of a flattened shape, con- 

ig for the most part of powdered drugs incorporated with sugar and 

mucilage. They are designated to be held in the mouth and dissolved 



LIQUID FORMS OF MEDICINE. 187 

slowly in the saliva, and are therefore adapted for the administration of 
those medicines which do not require to be given in large quantities, and 
are destitute of any very disagreeable flavor. Electuaries are mixtures of 
the consistency of jam, made up of medicinal substances, especially dry 
powders, combined with syrup or honey. Decoctions are solutions of 
vegetable principles made by boiling the substances containing them in 
water. As a rule, they do not keep well, and should be freshly prepared at 
least once in forty-eight hours. Infusions are similar preparations made 
with hot or cold water, without boiling. The proportion of drugs and 
water used in decoctions and infusions varies to such a degree that no rule 
for making them can be applicable in all cases. Information on this point 
should in every instance be sought from the chemist from whom the drugs 
are purchased. 

Spirits are the alcoholic solutions of volatile principles, formerly, in 
general, procured by distillation, but now frequently prepared by simply 
dissolving the volatile principle in alcohol of full strength or diluted. 
Tinctures are solutions of medicinal substances in strong or dilute alcohol, 
and are prepared by maceration, digestion, or percolation. The distinctive 
character of fluid extracts is the concentration of the active ingredients of 
medicinal substances into a small bulk in the liquid form. A saturated 
solution of any substance is one that contains all that can be dissolved in 
it. An emulsion is a mixture of oil and water, made by using gum arable, 
sugar, the yolk of an egg, or other viscid matter. The object of these 
preparations is to render the administration of oils easier., to conceal their 
taste, and obviate their nauseating effect. 

The age of the patient is a most important consideration in the use of 
drugs. The young require a much smaller close than those at maturity to 
produce an equal effect, and the extremely aged cannot bear equally as 
powerful medicines as may be safely given at middle life. For children 
under twelve years the doses of medicines can be estimated by the follow- 
ing simple rule : to the age add twelve, and divide by the age. Thus, if 
a child is two years old, the sum of twelve added is fourteen, and of this 
two is one-seventh. If, therefore, an adult dose of any agent is twenty- 
eight drops, then four drops given a child two years old would have an 
equal effect. Of the powerful narcotics scarcely more than one-half this 
proportion should be used. For children between twelve and twenty-one 
years old, the dose should be proportionately increased according to the 
age, judgment and discretion being used in its division. In nearly all 
instances, probably two-thirds the adult's dose at fifteen, and three-fourths 
at eighteen years, would be within the limits of safety in using even the 
most powerful agents. There are exceptions to this rule ; castor-oil, for 
instance, is much less active in children than in adults. 

Constitutional peculiarities often exist in individuals, rendering them 
more than usually susceptible or insusceptible to the action of certain reme- 



188 MEDICINES AND THEIR ADMINISTRATION. 

dies. This is especially true o( narcotics, the common doses of which affect 
some persons readily, while others tolerate much larger quantities. The same 
may be said of calomel, one or two grains of which will excite salivation 
in some patients, while in others scarcely any quantity which can be safely 
administered will induce it. Habit also materially modifies the dose of 
medicines. Generally speaking, the susceptibility to the action of drugs 
is diminished by their frequent and continued use, so that after a time 
increased quantities are required to produce the same effect. This is unde- 
niably true in regard to narcotics, which are sometimes borne in enormous 
quantities by those habituated to their use. 

It is important to remember that, if a medicine has been gradually 
increased, and then is for a time discontinued, the system renews its sus- 
ceptibility, is no longer tolerant of excessive quantities, and, if the same 
medicine is again employed, then on recommencing it the patient must 
return to the smallest dose, or too powerful effects may follow. 

While, as a general rule, the system becomes less susceptible to the 
action of a drug after its frequent and continued use, there are irnpor- 
tant exceptions, which must not be overlooked. Digitalis, for instance, 
after having been given in moderate doses for several days, without 
apparent effect, sometimes acts suddenly with an accumulated influ- 
ence, even endangering life. In using medicines of like peculiarities, 
they should be taken in gradually decreasing rather than in increasing- 
doses. 

The action of drugs is measurably assisted or obstructed by mental 
influences. If a jmtient becomes prejudiced against a medicine, and 
obstinately insists upon its inefficiency, a change, if possible, should be 
made; often a slight difference in appearance and flavor will be quite suf- 
ficient, if the complainant is kept in ignorance of the device. It is evi- 
dent that in many cases the invalid should not know the nature of the 
remedy which he is taking. There are few physicians in practice who 
cannot recall patients of vivid imagination, astonishingly susceptible to a 
supposed mixture of morphine, actually composed of a minute quantity of 
quinine in water. 

In the use of narcotics, good judgment and extreme carefulness are 
indispensable. They are perfectly harmless Avhen properly employed, but 
in the hands of the careless and incompetent they become agents of the 
greatest malignity. Of all narcotics opium is most frequently used, and 
therefore most liable to abuse. One grain of this is a dose for an adult. 
That quantity exists in ten grains of Dover's powder, in twenty-five drops 
of laudanum, in about one tablespoonful of paregoric, and is equivalent to 
one-eighth of a grain of morphine. Opium and its preparations have 
especial virtues which no other drug possesses. Other agents and combi- 
nations have been sought as substitutes, but none have been discovered so 
clearly antagonistic to pain. 



THE USE OF OPIATES. 189 

Opium should never be given unless its use is imperatively demanded, 
and then it should not be withheld. In correct doses, with sufficient inter- 
vals allowed between each, it may be employed without fear of injury. 
It is important to remember that when opium or any of its preparations 
is taken into the stomach, a certain period must elapse before its action 
is felt. If that organ is empty, the system begins to feel the narcotic 
influence in about thirty minutes ; if other solids or fluids are met, then 
absorption is delayed. Ordinarily the full effects of opiates are manifested 
in between two and three hours, and the dose should never be repeated 
within this limit, unless sanctioned by a physician. In attacks of pain of 
moderate intensity, opiates may be given at intervals of from three to Ave 
hours, as the need is manifest. If suffering is intense, they can gener- 
ally be safely administered every two or three hours until the pain begins 
to lessen, and then the intervals should be lengthened. 

In all cases, as soon as their work is accomplished, opiates should at 
once be discontinued, or but rarely given. Pain is the antidote for opium, 
and while the former exists, the latter can safely be employed, if judgment 
and discretion are used. In painful attacks of a functional character, the 
dose should never be repeated until there is good reason to believe that the 
one already given is insufficient to bring relief. The reason for especial 
caution in such instances is this : the pain is liable to cease suddenly, and 
then, the antidote being no longer present, the narcotic would act with 
greater intensity, and poisoning result, were the system heavily loaded with 
the drug. The characteristic action of opiates is to subdue pain, if any 
exists, and produce sleep. Patients who have been long suffering are often 
slow to acknowledge relief, even when it conies. In such cases, if they 
grow sleepy, it is an evidence that their distress is lessening under the 
influence of the agent employed. 

It is important to remember that medicines can be repeated, but, when 
once given, they are with great difficulty recalled. In all cases, therefore, 
it is far better to give too small doses than too large, and especially is this 
true in the case of opiates. The question naturally suggests itself, what 
form of opium is the most efficacious ? If all its preparations are honestly 
made, there is practically little, if any, difference or choice. The drug is 
expensive, and adulteration is grievously common. Pills of opium, con- 
taining one grain each, or granules of morphia, one-eighth of a grain, are 
convenient, and if coated with sugar or gelatine they change little or none 
by keeping. To promote sleep in short fevers characterized by high tem- 
perature, Dover's powder, the dose of which is ten grains, is more 
commonly used. The dose of laudanum, twenty-five drops, can be easily 
graduated, and the same may be said of paregoric, which contains camphor 
combined with opium. The union of these two drugs intensifies in a 
measure the action of both, and two teaspoonfuls of paregoric, of standard 
strength and reliable manufacture, may be considered a perfectly safe dose 



190 MEDICINES AND THEIR ADMINISTRATION. 

for an adult. Whatever preparation of opium is in use, it should be clearly 
labelled, and laudanum especially ought to be marked poison. 

That there is great danger of becoming dependent upon the use of 
narcotics must not be forgotten. The opium-habit especially is so easily 
acquired, so difficult to overcome, and entails such abject misery and utter 
destruction, the greatest care should be taken to avoid it. Let opiates be 
used it needed, but the necessity should be absolute to warrant their 
employment, and not a single dose is allowable after it becomes evident 
that the cause for which they are given is being removed. 

Almost all drugs act more powerfully on an empty stomach. Some 
arc. however, too irritating to be borne alone. Arsenic, iron, and cod-liver 
oil, should always be given after eating, to mingle and be slowly absorbed 
with the food. It is generally advisable to administer bitter tonics just 
before meals. Quinine and acids coagulate milk; therefore they should 
not enter the stomach together. Expectorant medicines and narcotics tend 
to retard digestion, and nausea results, if an interval is not allowed between 
them and food. 

Iron and the mineral acids should be drawn into the mouth through a 
glass tube, to prevent injury to the teeth. Oil can be more easily taken in 
strong coffee or lemon-juice. Castor-oil in the form of an emulsion 
becomes much less objectionable. To prepare it, beat up the dose to be 
administered with the white of an egg, and then add the juice of a lemon 
or a sufficient quantity of strong peppermint water; by this means the offen- 
sive taste is completely disguised. 

Many serious, and not a few fatal, mistakes have resulted from a want 
of care in administering medicines. All mixtures excepting those in use 
should be removed from the sick-room. Preparations for external applica- 
tion should in their appearance have some markedly distinctive feature. 
If not put in fluted bottles of colored glass, ribbons can be tied around 
the necks of those containing them. All bottles should be plainly labelled, 
and these ought to be carefully read before measuring the dose, and again 
afterwards. When drops are to be given, a dropping-tube should be pro- 
vided, and if an error is made the medicine should be thrown away, and 
another attempt made. Let each measurement be absolutely correct. A 
medicine should never be given in the dark, or in an insufficient light. 
Always shake before opening the bottle ; it is often important, and always 
harmless. Return the cork as soon as possible. If mixtures are displeas- 
ingly strong in taste, they can be given in water, in quantity sufficient for 
the need. 

In cases of sudden sickness, time is often of the utmost importance. 
Not infrequently, by a simple remedy applied at once, a long illness may 
be averted. It is, therefore, desirable that all families should be provided 
with a few drugs with which to meet emergencies. These remedies can be 
inclosed in a small box, which should be kept locked, beyond the reach of 






apothecaries' and fluid measures. 191 

children, and yet easily accessible to the parents. Only a few will be 
needed, and the boxes and bottles containing them should be conveniently 
arranged and distinctly labelled. 

The medicines which may properly be selected are wine of ipecac, 
castor-oil, senna leaves, tincture of rhubarb, paregoric, a small bottle of 
laudanum (marked poison), live-grain tablets of Dover's powder, sweet spirit 
of nitre, syrup of squills, aromatic spirit of ammonia, and a small piece of 
caustic fastened to a quill and enclosed in a well corked bottle. These 
remedies are practically all that are necessary to be provided, if living at no 
great distance from a physician or druggist. 

In purchasing medicines, the most reliable dealers should be patronized ; 
it is poor economy to buy drugs where they are the cheapest, as they are 
almost sure to be adulterated. To apothecaries of known competence only 
should the compounding of prescriptions be intrusted. Nearly all mixtures 
undergo changes in character by age ; it is, therefore, wise to have small 
quantities prepared, and, when the use of one is permanently discontinued, 
what remains should be thrown away. 

In administering medicines, the doses should be measured with the 
greatest exactitude. Spoons are of a variable capacity, and graduated 
glasses are preferable ; they can be procured at any drug store. The tea- 
spoon of a century ago was smaller than the one now in common use. The 
former was properly considered a drachm measure, but the latter is nearly 
one-fourth larger. A minim, the smallest accurate liquid measure, is 
equivalent to one drop of water, and is taken as the standard by apothe- 
caries and physicians. It is, however, deemed wise in this book to obviate 
the need of using it, as in its measurement a minim-tube is necessary, and 
small quantities of liquid medicines can be more easily estimated by drops. 
While a minim of water is equivalent to one drop of the same liquid, 
there are many fluids a minim of which represents two, and of some it is 
equal to three drops. 

It is an uncertain mode to estimate by drops, unless uniformity is 
observed. Thus, a drop even of the same liquid varies much in bulk 
according to the circumstances under which it is formed. In dropping from 
a bottle, over a cork, or through a tube, there would be a difference in bulk. 
Again, a drop from a full bottle would be less than from one more or less 
emptied. The broader the surface, also, from which they fall, the greater is 
their size. It is evident, therefore, that a dropping-tube should always be 
used, both for convenience and accuracy. 



apothecaries' measures. fluid measures. 

mix f 3 j 

f3 viij f^ j 



gr. xx 3 j 

3 hj 3 j 

3 viij ....... ^ j 

5 xij lb j 



f? xvj Oj 

O viij C j 



192 MEDICINES AND THEIR ADMINISTRATION. 

APPROXIMATE MEASURES. 

1 teaspoon contains about 1 fluid drachm ( 3 j). 

1 tablespoon " " -J fluid ounce ( 3 ss). 

1 wine-glass " " 2 fluid ounces (3 ij). 

1 tea-cup " " 4 ■' " (3 iv). 

1 coffee-cup " " 8 " " (3 viij). 

While tlie more common mode of introducing medicines into the 
system is by the stomach, there are occasionally cases in which, owing to 
persistent vomiting and other causes, it is expedient to administer food 
and remedial agents by the rectum. This method will be considered under 
enemata, in the following section. 



ENEMATA. 

Enemata, or clysters, are liquid preparations for injection into the 
rectum. Enemata may be used to secure or control evacuations from the 
bowel ; to obtain the peculiar impression of a remedy upon the lower por- 
tion of the intestinal canal and neighboring organs, or upon the system 
generally; or for the administration of nourishment. They are usually 
employed to assist the action of remedies taken by the mouth, or to supply 
their place when the stomach rejects them, or is insensible to their impres- 
sion. Sometimes they are preferably used to secure a local effect in dis- 
orders of the lower abdominal organs. When, as is often the case with 
opiates, gastric disturbance is induced by their use, this unpleasant effect 
is obviated, and yet their full influence felt by the system, when they are 
injected into the bowel. 

Doubtless the most general use of enemata is for the relief of constipa- 
tion. Water alone is sometimes used, but soap-suds are more commonly 
employed, and are both efficacious and convenient. Olive-oil is occasionally 
injected, and, in cases of abdominal distention from gaseous accumulation, 
turpentine is an active agent in relieving the distress. The former should 
always be first warmed before being used, as, w T hen cold, it is too thick to 
pass through a syringe readily; generally from four to six ounces will be 
needed to be effective. Turpentine should be first emulsified before 
injected. The quantity proper for an adult, a tablespoonful, should be 
well beaten up with the whites of tw r o eggs and tw T o or three ounces of 
olive-oil, or one or two of castor-oil. 

When the object is to evacuate the bowels, the quantity of liquid 
administered should be, for an adult, from one to three pints; for a child 
eight to ten years, half that quantity ; for an infant within the year, from 
one to three ounces. Much larger quantities of liquids may sometimes be 
given with safety. Laxative enemata are not only active in washing out 
the contents of the bowel, but they also stimulate by distention and in- 
crease the activity of the entire intestinal tract. Physicians often meet, 



MEDICINES AND FOOD BY INJECTION. 193 

among the ignorant, prejudice against the use of injections, they being 
thought injurious. Nothing could be more absurd than this fancy, if their 
use is only occasional. When, however, they are persistently and con- 
tinuously employed, they cause undue distention and render the bowel less 
sensitive to impressions. In administering soap-suds or other fluids for a 
similar purpose, a bulb syringe, such as the Davidson, is the best. The 
patient should lie on the left side, the bed having been carefully protected, 
and the tube, well oiled, should be very' gently inserted upward, slightly 
backward, and toward the left. The injection should be given very slowly ; 
otherwise the desire for relief by expulsion will become imperative. The 
process cannot be hurried, and if pain be induced it will generally quickly 
subside if the stream is interrupted for a few moments. After a short 
delay the operation can be renewed, and persisted in until sufficient quan- 
tity of the fluid has been thrown in. The tube should be then gently 
withdrawn, and the patient encouraged to remain in bed ten or fifteen 
minutes if possible. To assist in retaining an enema this length of time, 
a folded towel should, if necessary, be firmly pressed against the opening of 
the bowel. When obstinate constipation exists, and there is reason to believe 
that hardened masses are lodged within the rectum, an injection of four or 
five ounces of olive-oil may be given half an hour before one of water, and 
allowed to remain to soften the deposit to be expelled. 

As a general rule, enemata of the same temperature as the body are 
the most easily borne,, They can be used without inconvenience to the 
patient, either hot or cold, and the extremes excite a more vigorous action 
of the intestines. If the object be simply to evacuate the bow r els, fluids 
should be of a mean temperature,, A daily injection of a pint of cold 
water is often advised in cases of constipation attended by bleeding 
hemorrhoids, or a relaxed state of the bowel. A solution of salt, one tea- 
spoonful to the pint of water, is a common remedy for pin-worms. For an 
adult, an injection of half a pint is sufficient ; for a child, still less. Injec- 
tions of a soothing character, made of flaxseed tea, and. decoctions of a 
similar character, are frequently used in irritable conditions of the intesti- 
nal mucous membrane. In diarrhoea, starch injections are frequently 
advised. The starch should be added to sufficient water and the solution 
made thin enough to pass readily through the syringe. It is customary to 
use about two fluid ounces of this preparation, and to add to each enema 
thirty drops of laudanum. As a general rule, these injections can be 
repeated every two or three hours. If opiates are administered by the 
mouth in cases of diarrhoea, they must either be lessened in quantity, or 
discontinued, if much laudanum is introduced into the rectum. 

Opiates are frequently given by injection for the relief of pain in the 
lower part of the abdomen. As a general rule, about one-third more of any 
drug than the dose given by the mouth is needed, when administered by 
enema, to produce the same effect. An injection, to be retained, must be of 



HU MEDICINES AND THEIR ADMINISTRATION. 

the same temp era tare as the body, and should not in quantity exceed four 
ounces. The patient should remain perfectly quiet after it is taken; the 
desire to expel it may be strong at first, but the discomfort soon subsides. 

Nourishing enemata are now much more frequently advised than 
formerly, as the absorbent power of the rectum has been more fully deter- 
mined. Xot only by their use can life be prolonged, but in many cases it 
is saved by this mode of supportive treatment. The writer recalls one 
ease in his earlier practice, that of a woman suffering from cancer of the 
stomach, whom he sustained for thirty-two days on nourishing enemata 
alone, absolutely nothing being taken into the stomach during that entire 
period. Any highly concentrated food can be given by the rectum. 
Milk, cream, strong beef-tea, and raw eggs well beaten, are most commonly 
selected. Stimulants, if needed, can be given alone or with the nutriment, 
and a popular enema is three ounces of beef-tea, half an ounce of brandy, 
and one of cream. As a general rule, it is well to add to each injection, to 
favor its retention, at least fifteen drops of laudanum. If they are to be 
given continuously, one in five or six hours is often enough, and four 
ounces of liquid the largest quantity allowable. If repeated at shorter 
intervals, there is danger of irritating the intestinal mucous membrane. 
The bowel should be evacuated before nourishing enemata are administered ; 
if they are given daily, an injection of warm water before the first in the 
morning will suffice for the day. 

Suppositories are solid bodies for introduction into the rectum, and, as 
generally prepared, they contain a medicine the peculiar effect of which it 
is desirable to communicate to the neighboring organs or to the system at 
large. They are of various sizes, and firm enough, under ordinary circum- 
stances, to retain their shape until introduced ; they then melt easily under 
the heat of the body. Cacao butter and wax are the substances of which 
suppositories are principally composed, and in these are the medicines 
incorporated which it is desirable to use. Opium or some of its prepara- 
tions is very advantageously administered in this manner; so too, in a like 
form, are many other drugs introduced into the system. After being well 
oiled, the suppository should be pushed up the passage, at least one-half 
the length of the finger beyond the opening. If perfect quiet is enforced, 
the rectum soon becomes accustomed to its presence and the expulsive 
desire subsides. 



BOOK FIFTH. 



THE PRACTICE OE MEDICINE, 



INTRODUCTORY. 

In treating of individual diseases, the classification of Dr. Austin Flint, 
in his "Principles and Practice of Medicine," has been chosen, as being the 
most comprehensive and convenient for ready reference. The work alluded 
to is the acknowledged standard treatise for practitioners and students of 
medicine, and is the popular text-book in all medical colleges of promi- 
nence in America. From this classification the author will vary but 
slightly, omitting the discussion of those diseases rarely encountered and 
difficult of recognition even to the most skilful physician. All the more 
common, and likewise the occasional, affections will be fully considered ; 
also, many which properly belong to the province of surgery. 

In the consideration of each disease, much space will be devoted to the 
study of symptoms, and the order in which they appear during its progress 
and development. Under the head of causation will be stated the known 
causes or probable influences active in determining the diseased conditions. 
The importance of diagnosis is fully recognized, and, when necessary, the 
evidences against the existence of other diseases which have more or less 
symptomatic phenomena in common will be considered. Under the head 
of prognosis will be embraced the intrinsic tendency of diseases, as regards 
termination in recovery or death, and the manifestations which character- 
ize a favorable or unfavorable progress. In this connection there will also 
be considered the complications which are liable to occur in the course of 
a disease, and their probable consequences. The consideration of the 
treatment of each disease will embrace not only the indications for the use 
of medicines and the appropriate remedial agents, but also hygienic meas- 
ures, of scarcely less importance. The means of prevention, and those 
measures which remove or obviate the cause of disease are intimately 
associated with the study of treatment, and in its connection will claim con- 
sideration. 

195 



196 THE PRACTICE OF MEDICINE. 

►re entering upon tbe consideration of individual disease?, it is 

ss utial to understand certain points of distinction, interesting, and of 
practical importance. 

Differences as regards severity and duration constitute a division of 

diseases into varieties. The same disease may be acute, sub-acute, or 
lie. A disease is acute when it has a certain degree of intensity, 
and terminates in a short time. The sub-acute variety lias less intensity; 
the term is applied to diseases of moderate activity. The chronic variety 
exists when a disease is sub-acute, and is of long continuance. The division 
of inflammatory affections into varieties is based on the differences named. 

A point of distinction of practical importance relates to duration. 
Some diseases run a definite course, but little modified by treatment, and 
never exceed certain limits. Those which naturally tend to end after a 
certain time are distinguished as self-limited. 

It will be observed that the term expectant is occasionally used. The 
treatment of a dieease by expectation consists in watching carefully its 
progress, and meeting with appropriate measures unfavorable events as 
they arise, in fact, withholding active treatment until the need is manifested. 
The so-called abortive measures are those employed to arrest the progress 
of a disease, or cut it short in the first stage. Palliative measures are 
employed to relieve pain or suffering. Sustaining or supportive measures 
consist of tonic remedies, stimulants, and food, and have reference more 
especially to acute diseases of great intensity, which threaten life by pros- 
tration of the vital forces. 

Examination by palpatio?! is touching, feeling, exploring by the hand. 
It is an important means of diagnosis, especially in disease of the abdomi- 
nal organs, as by it can be determined tenderness, distention, and other 
unnatural conditions attended with solidification or increase in size. 
Examination by inspection reveals deformities, unusual prominences, and 
other abnormalities of a like nature. 

There are many diseases, especially those of the heart and lungs, the 
positive diagnosis of which depends much upon the physical signs termed 
percussion and auscultation. Those signs are appreciable to the ear, and 
a familiarity with the sounds in health is essential in determining the 
existence of disease. Therefore only in a slight degree are they available 
to the reader, and a diagnosis in commencing pulmonary and cardiac dis- 
eases cannot be absolutely confirmed without the assistance of a physician. 
In describing the physical signs of individual diseases, only those plainly 
evident to all will be mentioned. 

To practise percussion, the middle finger of one hand should, be placed, 
with the palm downward, firmly on the -walls over the organ suspected of 
being diseased. By striking this finger sharp, quick blows from the wrist 
with the middle finger of the other hand, the various degrees of solidifica- 
tion beneath are determined. When air is present within, and beneath the 



INTRODUCTORY. 197 

finder, a hollow sound is emitted, while if none is present the sound is flat 
and deadened. These extremes may be demonstrated by percussing the 
top of a table, and a person's leg above the knee. 

Auscultation is usually practised in diseases of the chest, the ear being 
pressed closely to the walls of the same. By this method there are 
transmitted the respiratory sounds, those caused by the opening and 
shutting of the valves of the heart, and by the passage of the blood 
through the largest arteries. In all pulmonary and cardiac diseases there 
are physical signs of greater or less significance ; some of them are 
characteristic and pathognomonic. In many instances, they are easily 
recognized; in others, the sounds are so faintly heard, only a practised ear 
can detect them. 

Aside from individual diseases, there are many disturbances of health 
which, from their varying character, cannot be classified or even defined. 
To determine the causes in these conditions is as important and often 
more difficult than when disease has become firmly fixed and plainly 
evident. The knowledge and skill of a physician must in such cases be 
called into requisition. 

In prescribing drugs, simplicity will be observed, and, when possible, 
concentrated remedies advised, as they are generally more easily borne on 
the stomach, and less difficult to administer. It must not be forgotten 
that the dose in every instance is for an adult. 

To withhold medicine is as important in some cases as is its free use in 
others. The indications in disease must be carefully studied, and active 
treatment instituted only when the need is manifested. The efficacy of 
other measures, aside from the employment of drugs, should be appreciated, 
and every known influence, dietetic, hygienic, mental, or other, should be 
called to assist in the recovery of the sick. 

The author desires to impress upon the reader this fact, that the treat- 
ment of disease advised in this work is based not alone on his individual 
experience, but in it are embodied the most approved methods known to 
the medical world, and accepted by all eminent authorities and scientists 
in the practice of medicine at the present time. There is practically no 
difference in the methods of educated physicians in the treatment of 
disease. The list of remedial agents with common effects is very large, 
and it is not reasonable to suppose that they all employ identically the 
same. Thus, for an emetic, one physician may be habituated to using 
ipecac ; another, the sulphate of zinc ; while still another may prefer to give 
apomorphia sub-cutaneously ; in all instances, the same result follows the 
administration of any of these drugs. There are many agents which produce 
sleep ; among them are opium, chloral hydrate, the bromides, paraldehyde, 
etc. These remedies, while they possess certain distinctive features, yet 
have one common effect. The available material for similar illustrations 
is almost inexhaustible ; the limit can only be reached when every known 
remedial agent has been considered. 



SECTION I. 
DISEASES OF THE RESPIRATORY SYSTEM, 



CHAPTER I. 
ACUTE PLEURITIS. 



To facilitate the movements of the lungs, each of them is provided 
with a double covering of an exceedingly smooth and delicate membrane, 
called the pleura. One layer of this invests the surface of the lung, while 
the other lines the inner wall of the chest. The interspace or cavity 
between these layers is called the cavity of the pleura. The inner surface 
of the pleura is smooth, polished, and moistened by a thin, watery fluid, 
and the two layers glide one upon the other with utmost freedom, as the 
lungs alternately expand and collapse in movements of respiration. 

When the pleural membrane becomes inflamed, the secretion of the 
lubricating fluid is arrested, and, instead of gliding smoothly, the now dry 
surfaces rub upon each other at every respiratory movement. Inflamma- 
tion of the pleura, or plearitis, presents itself in different forms. It may 
be limited to a small portion of the membrane, in which case it is termed 
pleuritis circumscripta, or circumscribed pleurisy ; it is also called dry or 
fibrous pleurisy. The term circumscribed is used in contradistinction to 
the more common form of pleurisy, which, as a rule, spreads over a larger 
portion of the membrane. 

After the pleura is inflamed, and the surfaces are dry and roughened, 
they may become separated by an effusion of fluid into the pleural cavity, 
or, as in the case of circumscribed pleurisy, the disease may run its course 
without any noteworthy effusion. When little or no fluid forms, the 
inflamed pleural surface soon becomes coated with a material called 
fibrinous exudation, which renders it comparatively smooth. This may in 
time be absorbed, and thus all traces of the inflammation disappear ; or, as 
is often the case, the inflamed surfaces may become bound together, glued, 
as it were, by this adhesive secretion. When the common form of pleurisy 
occurs, the effusion generally begins to accumulate within twenty-four 
hours after the surfaces become inflamed. The quantity of fluid in the 
pleural cavity is at first small ; in some cases it is only a few ounces, and 
recovery takes place without this moderate limit being exceeded. In other 
cases it gradually or rapidly increases, finally amounting to several pints, 

198 



ACUTE PLEURITIS. !!>{> 

and in rare instances the quantity is sufficient to fill the cavity of the 
pleura, and compress the lung into a small, solid mass. ' r J nis effusion is a 
watery fluid, containing a fibrinous exudation of the same character as 
that which forms in circumscribed pleurisy. The adhesive material, after 
being poured out, soon coagulates, and the larger part of it is deposited 
on the inflamed surfaces, eventually forming bands of union between 
them. 

In some cases the effusion undergoes certain changes, and becomes 
purulent; the disease is then empyema, or suppurative pleuritis. This may 
occur quickly, even as early as the first week, but more often during the 
chronic stage it slowly assumes the purulent form. Very rarely the effu- 
sion becomes hemorrhagic, and is due to a constitutional hemorrhagic 
tendency, to blood-changes (as in scurvy), to peculiar forms of inflammation 
of the pleura, and sometimes it results from a newly excited inflammation 
in the exudative deposit formed in simple pleuritis. 

In cases of pleuritis progressing favorably, absorption of the material 
commences in a few days after the limit of accumulation has been 
reached. If this is removed in two or three weeks, and the feverish mani- 
festations, with the local symptoms of inflammation, are of but brief dura- 
tion, the pleuritis is termed acute. 

Of pleurisy it may be said that it affects the pleura of one side only. 
There are very few exceptions to this rule, and, when bilateral, or double, 
it may be presumed that the disease is secondary to some other pulmonary 
affection. Pleurisy is sometimes associated with pneumonia, as pleuro- 
pneumonia; it is also a frequent complication of certain other diseases of 
the lungs. 

Symptoms. Acute pleurisy presents itself in different forms ; it may 
be mild or severe, of moderate intensity and short duration, or run a 
stormy course, and recovery be delayed many weeks. In all instances the 
attack occurs with well marked symptoms. It sometimes, but very rarely, 
commences with a well pronounced chill, accompanied with a rigor. The 
invasion is more often characterized by chilly sensations and slight shiver- 
ings. In a proportion of cases pain or soreness in the affected side is felt 
for from one to three days before the development of the acute inflamma- 
tion. The so-called pleuritic pain, or " stitch in the side," is one of the 
most common symptoms at the onset of the disease, although it may some- 
times be entirely absent. It is estimated to be present in forty cases out of 
forty-six. The pain is limited to one small spot, and usually referred to 
the nipple. It is most often of a stabbing character, but is sometimes 
described as cutting, tearing, or dragging. This pain is increased by quick 
and deep inspirations, by coughing, sneezing, laughing, and often by external 
pressure. The patient endeavors to restrain the movements of the affected 
side, and when sitting assumes a peculiar position, leaning towards that 
side. When recumbent, he prefers to lie on the healthy lung during the 



'200 DISEASES OF THE RESPIRATORY SYSTEM. 

earlier stages, if the effusion which forms is but of moderate quantity. If, 
however, it is considerable, reaching several pints, then the position 
assumed is on the affected side. 

At Bret, in this disease the face is pale and wears an anxious, distressed 
look: after a few hours it becomes Hushed and slightly purplish if respira- 
tion is seriously interfered with. The pulse becomes quickened, ranging 
from ninety to one hundred and twenty, but in attacks of moderate 
intensity it rarely rises above one hundred per minute; it is firm and tense 
in character. In all cases of pleuritis the respiration is abnormally 
frequent ; in many, it is hurried, difficult, and painful. The intensity and 
duration of the pleuritic pain varies in each case ; sometimes it is agoniz- 
ing, more often it is of moderate severity, and in occasional instances it is 
slight, possibly absent, or felt only on coughing, sneezing, and the like. 

Generally, in pleuritis there is a cough from the first ; occasionally it 
appears late in the disease, and very rarely indeed is it absent. In 
character it is short, dry 3 tearing, and restrained on account of the pain 
which it produces. It is usually most severe in the first few days, and 
subsides or disappears when the effusion has attained a considerable 
amount, or the illness is on the decline. Occasionally, during the absorp- 
tion of the fluid, the cough returns for a short time. 

In very severe cases pleuritis manifests itself by the most violent 
symptoms. Such an attack usually comes on with a severe rigor, followed 
by high temperature, often reaching 105°. The respirations become very 
rapid, and the pulse, feeble in character, beats from one hundred and 
tw T enty to one hundred and forty per minute. Violent delirium, excessive 
thirst, tongue dry and cracked, are sometimes associate symptoms in these 
cases. Pain in the side is not so severe as in the milder attacks of the 
disease. 

Acute pleuritis occasionally runs a very mild course; but little fever is 
present, pain and difficulty in breathing are slight or absent, and the 
appreciable symptoms are not sufficiently pronounced to render the 
existence of the disease plainly evident. Patients so affected generally 
continue their wonted occupations, complaining only of an uncomfortable 
feeling in the side. 

Causation. Acute pleuritis occasionally owes its origin to direct 
exposure to cold. It may also arise in consequence of an injury to the 
chest, as from severe contusions, especially if accompanied with fractures of 
the ribs. The inflammation is excited by penetrating wounds which permit 
the entrance of air, blood, pus, or any foreign body, into the pleural cavity. 
Certain forms of pneumonia invite inflammation of the pleura; and even 
bronchial catarrhs, accompanied with severe and protracted fits of cough- 
ing, occasionally induce the affection. Pleuritis may be caused by the 
extension of disease from any of the organs adjacent to the pleura ; it may 
also occur as a complication of other diseases which have no apparent 






ACUTE PLEURITIS. 201 

connection with this membrane. Pleurises frequently appear in the 
course of chronic kidney troubles; also, as sequels to rheumatism, gout, and 
scarlet fever. In scurvy, and other constitutional disorders characterized 
by serious blood-changes, pleuritis occurs as a secondary affection. Wliile 
in some cases the cause of the disease is determinable, in a large propor- 
tion, however, its origin cannot be traced. 

Diagnosis. The symptoms already described are characteristic of 
acute pleuritis, and when present they point to the existence of that dis- 
ease. They are not sufficient, however, for a diagnosis in all cases, and the 
physical signs must be studied. During the first twenty-four hours, exami- 
nation by inspection will show the movements of the chest, on the side to 
which the pain is referred, to be more or less restrained. On auscultation, 
a respiratory sound will be less distinct on the affected side, and a grazing 
friction-sound will be heard. When the latter is present, it is almost 
certainly indicative of pleuritis. It is commonly heard on both inspiration 
and expiration, but there are intermissions during which the inflamed sur- 
faces seem to adhere to each other, and are only separated by a deeper 
inspiration. An examination should be made leisurely, and the friction- 
sound sought at different points, as it may appear more distinct at some 
than at others. As the disease progresses and the effusion forms, there is 
a diminution or absence of the respiratory sound below the level of the 
liquid. Percussion is now of assistance, and as the pleural cavity becomes 
filled there is flatness over the region occupied by the fluid. The expansive 
movements of the chest are still more restricted ; the spaces between the 
ribs widen, and if the effusion is great they bulge externally. During the 
absorption of the fluid, there is a gradual return of the normal respiratory 
sounds, and, unless the disease has been very severe, the chest returns to its 
original shape. The friction-sound assumes more of a rubbing character, 
and, in some instances, remains audible after all other signs of pleuritis 
have disappeared. 

The diagnosis of acute pleuritis is, in the majority of cases, easily 
made. Acute pneumonia is the only disease with which it is liable to be 
confounded. In both affections there are difficult breathing, fever and 
cough, but pneumonia is ushered in with a rigor which is immediately 
followed by continuous high fever and a temperature over 103° ; while in 
pleurisy it rarely rises above 100°. The cough of pleurisy is short and 
hacking, little or nothing being raised ; whereas in pneumonia there is 
almost always present the rust-colored expectoration which is characteristic 
of the disease. Again, in pleurisy is heard the friction-sound, wliile no 
sound which resembles it is present in pneumonia. Extremely violent 
attacks of pleurisy, attended with delirium and great prostration, have 
sometimes been mistaken for typhoid, but the history of a sudden invasion 
and the physical signs ought to exclude that disease. Intercostal neuralgia 
and pleurodynia are sometimes confounded with acute pleurisy, but a 



. _ DISEASES OF THE RESPIRATORY SYSTEM. 

careful study of these affections will show that they have but few symptoms 
in common. 

Prognosis. The prognosis in eases of acute pleuritis occurring as an 
independent disease, and in previously healthy patients, is almost always 
favorable. In the very rare cases characterized by typhoidal symptoms, 
death results. Cases are also recorded where fatal terminations seemed fairly 
attributable to large and rapidly formed effusions. The average duration 
of an attack of acute primary pleuritis is from two to five weeks. It is to 
be remembered that patients who have experienced even mild forms of the 
disease are predisposed to other attacks. Acute secondary pleuritis some- 
times runs a favorable course and ends in complete recovery. This result 
is, however, uncommon, and when occurring in the course of other and 
grave diseases, or in persons of enfeebled constitutions, it may destroy life 
by impoverishing the vital forces. 

Treatment. For the successful management of acute pleuritis, even of 
a mild character, it is important that the patient be placed in bed, in a 
well ventilated room kept at an even temperature of about 65°. He 
should be allowed to assume the position which he finds most comfortable, 
be enjoined to avoid all unnecessary movements, and forbidden to talk. 
In the beginning of an attack it is well to open the bowels with a saline 
purgative, such as the solution of the citrate of magnesia or a cathartic of 
a similar character. A nutritious diet should be allowed, and stimulants 
strictly prohibited. The one remedial agent of acknowledged efficacy in 
the first stage of the disease is opium in some form. It not only relieves 
the patient's pain and nervous manifestations, but it also checks, to some 
extent, the determination of blood to the inflamed pleural surfaces. One 
grain of opium, or ten grains of Dover's powder, should be given every 
four or six hours, as needed, and mustard poultices or flannels wrung 
from hot water applied to the affected side. The pain caused by the 
movements of the lungs in inspiration is greatly relieved by tightly ban- 
daging the chest. If the attack is severe and attended with considerable 
fever, ten grains of quinine may be given every six hours for twenty-four 
hours. 

If the pain and feverish manifestations subside rapidly, few patients 
need be confined to the bed more than a week, and at the end of three 
weeks many will be able to resume their ordinary occupations. If a large 
effusion forms, recovery will necessarily be delayed ; the patient must be 
confined to his room and exertion avoided. Free movements of the 
bowels should be encouraged by saline laxatives, and cream of tartar 
water drank freely. Tonics will more often be needed, and the syrup of 
the iodide of iron, in half-drachm doses, should be given four times a day, 
in a wine-glassful of water. The absorption of the fluid may be hastened 
by counter-irritation, the most simple and effective means being the 
application of iodine to the affected side. If the quantity of effusion in 



CHRONIC PLEURITIS. 203 

the pleural cavity is sufficient to seriously interfere with the breathing, the 
chest must be tapped by a physician, and the fluid slowly withdrawn. 
The diet throughout the disease should be generous and nutritious. 
Stimulants, which are forbidden while the inflammatory symptoms are 
present, may, after they subside, be allowed if there is any evidence that 
the strength of the patient is giving way. 



CHRONIC PLEURITIS. 

Chronic pleuritis is much more common than the acute form. The 
inflammatory process invades the whole of the pleura on the side affected. 
The cavity is partially or completely filled with a serous effusion, and the 
anatomical changes are similar to those which- take place in acute pleurisy. 
Frequently the quantity of fluid is sufficient to compress the lung into a 
solid mass, dilate the walls of the chest, push out the spaces between the 
ribs, and sometimes displace the heart from its normal situation. After the 
liquid is absorbed, the affected side contracts, the shoulder is lowered, and 
spinal curvature is apt to ensue. The compressed lung does not expand 
to its original dimensions when the pressure of the liquid is removed, 
being prevented by the changes which take place in the pleural covering. 
The longer the fluid remains in the cavity, the more extensive will be the 
retraction of the affected side, and in some cases the chest presents an 
appearance as if the lower ribs had been crushed inward. 

Symptoms. Chronic pleuritis occasionally follows the acute form; in 
the majority of cases, however, it is a sub-acute affection from the first, 
and comes on insidiously, with very mild symptoms. Early in the disease, 
in some instances, patients complain of an uneasy sensation in the affected 
side, with occasional sharp pains lasting but for a moment. Pain is, how- 
ever, more often absent, or, when present, it is scarcely sufficient to attract 
attention. As one author says: "This form of pleurisy is often so 
insidious in its approach that the patient will be unable to tell when he 
commenced to be sick ; for a period of several weeks he will have gradu- 
ally lost flesh and strength, yet will have been able to attend to his ordinary 
avocations, if they required but little physical exertion." 

If the pleuritis is accompanied by a large effusion, "shortness of 
breath" will be a characteristic symptom. This deficiency becomes 
marked after exercise, and especially noticeable on speaking, the sentences 
being broken and interrupted at short intervals by an effort to fill the 
lungs. The pulse is generally quickened, and becomes small and compres- 
sible. Night sweats are of frequent occurrence, and slight chills are not 
unusual. Cough is rarely a prominent symptom, and if present it is short, 
dry, and hacking, with scanty expectoration, consisting of mucus. In some 
cases, the appetite continues good ; in others, it is notably impaired. 
Digestion is more often unaffected ; occasionally diarrhoea occurs. Gener- 



201 DISEASES OF THE RESPIRATORY SYSTEM. 

ally the face becomes pale, and shows poverty of the blood; in rare 
instances, the aspect oi health is maintained. When the disease is unasso- 
eiated with other affections, emaciation is not usually marked. 

Causation. Chronic pleuritis may follow the acute form of the disease, 
but more often it is developed after exposure to cold, wet, and fatigue, in 
persons already enfeebled or suffering from some long-existing affection. 
It may be associated with pulmonary consumption, and chronic diseases of 
other organs, especially of the kidneys; in a large majority of cases its 
origin cannot be determined. 

sis. In uncomplicated cases of chronic pleuritis, attended with 
a large effusion, a diagnosis is usually very readily made. The physical 
signs are the same in this as in the acute form, and need not be again 
stated. In chronic pleurisy the dilatation of the affected side is more 
often noticeable to the eye, and the contrast between that and the healthy 
side is usually plainly evident. 

In a proportion of cases the presence of fluid in the pleural cavity cannot 
be positively determined without tapping the chest with a small aspirating 
needle. This operation, when performed by an intelligent physician, is 
absolutely harmless. When chronic pleuritis occurs as a secondary affec- 
tion, dependent upon grave organic diseases, the characteristic symptoms 
will be modified and new be added. If consumption co-exists, cough is 
more prominent and expectoration more profuse. Emaciation and general 
loss of strength are also marked. When associated with cardiac dis- 
ease, the circulation is more disturbed and the difficulties in breathing 
increased. If co-existent with severe kidney affections, general dropsy is 
commonly present. 

While the diagnosis of chronic pleuritis is readily made in some cases. 
in others, when attended with complications, it is exceedingly difficult, 
even for a professional. It is therefore impossible to so instruct a layman 
he can positively determine the existence of this disease in all instances. 
The symptoms already described will, however, when noted in a patient, 
at least point to the pleura as the possible seat of the affection from which 
he is suffering. 

Prognosis. Chronic pleuritis, occurring in jDreviously healthy persons, 
and uncomplicated with other serious affections, tends to recovery. The 
prognosis is always unfavorable if the constitution of the patient has been 
impaired by other illnesses, his blood is impoverished, or he is predisposed 
to consumption. Death may be caused by a rapid increase of the effusion, 
but such a result is exceedingly rare. The fluid contained in the pleural 
cavity sometimes becomes purulent, and the disease is then changed into 
empyema. If the effusion is large and absorption takes place slowly, the 
affected side never returns to its original shape, nor is the lung entirely 
restored. After recovery from chronic pleuritis, there is great danger of a 
relapse. 



EMPYEMA — SUPPURATIVE PLEURITIS. 205 

Treatment. It is important in the treatment of the disease under con- 
sideration to remove the effusion as rapidly as possible, and at the same 
time to develop and sustain the powers of the system. If the quantity 
of fluid is small, counter-irritation, conjoined with the use of tonic reme- 
dies, hygienic and supportive measures, in some cases will effect recovery. 
The side should be painted once or twice daily with the tincture of iodine, 
and the syrup of the iodide of iron given, in half-drachm doses at first, and 
gradually increased to one drachm, three or four times a day. The most 
nutritious food in generous quantities, and alcoholic stimulants in some 
form, should be administered. The principle of treatment is to employ 
every known means to improve the general health. If the quantity of 
effusion is sufficient to seriously interfere with respiration, or is increasing 
after the cavity is half filled, then the fluid should be withdrawn by tap- 
ping. The same operation should be performed in all cases, if absorption 
does not commence within a week after the employment of the medical 
treatment advised. 



EMPYEMA - SUPPURATIVE PLEURITIS. 

In empyema, or, as it is termed, suppurative or purulent pleuritis, the 
fluid portion of the exudation in the pleural cavity is pus, of a thick, 
turbid, and grayish-yellow appearance. It is generally accepted that in 
almost every case the effusion is at first fibrino-serous, as in simple 
pleuritis, and, during the subsequent course, sooner or later it becomes 
purulent. 

Symptoms. Many of the signs and symptoms in suppurative pleuritis 
are essentially the same as in the simple form of the disease, and which 
characterize the presence of liquid in the pleural cavity. When the effu- 
sion becomes purulent, the patient is usually attacked with chills ; there is 
a rise in temperature, intense pain, a puffiness of the sub-cutaneous tissues 
on the affected side, and much greater prostration. These manifestations 
will, however, hardly warrant a positive diagnosis. The symptoms of 
chronic empyema are often obscure. Pain is rarely suffered ; there is 
simply a sense of uneasiness or weight in the affected side. The patient 
gradually loses flesh and strength ; a chill occurs daily, followed by profuse 
sweats; the countenance becomes pale, haggard, and anxious. More often 
he has a cough, with a scanty, yellowish expectoration ; his voice is weak, 
and breathing difficult. Gradually he sinks from exhaustion, assuming the 
appearance of a patient in the last stages of consumption. 

Causation. The disease may be produced traumatically ; it also occurs 
from internal causative agencies, the exact nature of which is unknown. 
In the latter case it is always associated with some constitutional impair- 
ment, such as results from exhausting disease, or the debility which is 
propagated by intemperate habits. In pulmonary consumption, abscesses 



-06 DISEASES OF THE RESPIRATORY SYSTEM. 

of the lung are occasionally discharged into the pleural cavity ; the same 

may be said of abscesses of the liver, or in the abdominal cavity. In 
either instance empyema results. 

gnosis. While it may be inferred from the signs and symptoms 
that the effusion is of a purulent character, it cannot be positively deter- 
mined unless the walls of the chest on the affected side become perforated, 
or some of the fluid be drawn off by tapping. 

Prognosis. The prognosis in empyema is always unfavorable. As a 
general rule, only those cases terminate favorably which are relieved by 
operative measures, and the pus is discharged outwardly. Recovery can 
only be hoped for when the disease is uncomplicated, and in patients 
endowed with good constitutions. In many fatal cases life is prolonged for 
a year or more ; death then occurs from exhaustion. 

Treatment. The operative treatment which promises the best results is 
the making of a large permanent opening at the bottom of the pleural 
cavity, allowing the pus to freely escape. In this procedure a careful 
observance of antiseptic precautions is of the utmost importance. The 
object of general treatment should be to build up the system and restore 
the vital powers. Quinine and iron are always indicated; cod-liver oil, 
when it can be well borne ; and no less essential are pure air, a generous, 
nutritious diet, and stimulation. 



CHAPTER II. 
ACUTE LOBAR PNEUMONITIS. 

Acute pneumonia usually involves at least an entire lobe of a lung, and 
hence the name of lobar. This affection is termed croupous pneumonia, 
and is also popularly known as lung fever. It is a disease seated in the 
air-cells and minute connecting bronchial tubes, attended with an exuda- 
tion which tills these spaces, and renders them impermeable to air. The 
fluid poured out coagulates, and thus the portion of the lung affected 
becomes solidified, and presents an appearance not unlike that of liver; 
hence the name hepatization. 

Each lung is divided into lobes, — the right lung into three, the left 
into two. Pneumonia, in the great majority of cases, attacks the lower 
lobe, and that of the right oftener than of the left. In exceptional cases, 
it appears first in the upper lobes. The disease does not extend from one 
lung to another, but when a new lobe is affected it is the seat of a new 
invasion. It may be confined to one lobe, or the entire lung become 
involved, and in a small per cent of cases lobes on both sides are attacked, 
in which cases the disease is called double pneumonia. 

Symptoms. Acute pneumonia may be divided into three stages. The 
first stage embraces the ]3eriod of congestion, in which all the blood-vessels 
of the portion of the lung involved are distended with blood. This is also 
called the stage of engorgement. The disease is considered to have entered 
the second stage when the greater part of the air-cells of the affected lobe 
have been filled with the exudation. This stage is called the stage of 
solidification, or hepatization. As defined by Flint, "in the third stage the 
affected lobe is in one of two conditions. If the disease pursue a favora- 
ble course, the third stage begins when it is evident that absorption of the 
exuded matter is going on, and convalescence takes place during this 
period. If the disease pursue an unfavorable course, the third stage is one 
of suppuration or purulent infiltration, and this stage may be called the 
purulent or suppurative stage. If this stage occurs, the disease generally 
ends fatally." The first stage generally lasts from one to three days, and 
the second from three to seven days. The length of the third stage is 
exceedingly variable; in the majority of cases, its duration is from three to 

207 



208 DISEASES OF THE RESPIRATORY SYSTEM. 

ten days, and sometimes three weeks must elapse before the affected 
lung returns to its normal condition. If the disease passes into the 
purulent stage, death usually results from exhaustion within a few clays. 
If lecovery from this stage takes place, it is slow, and convalescence 
tedious. 

Generally acute pneumonia commences with a chill, frequently accom- 
panied with rigors. This more often occurs at night, and the chill is 
intense and prolonged, lasting from half an hour to several hours. Pain 
occurs with the chill, or generally speedily follows it; in occasional cases, it 
is delayed several hours. It is sharp and stabbing, and is felt under- 
neath the nipple of the affected side. This rarely continues beyond 
the third or fourth day, and may be slight or severe, and in some cases 
altogether wanting. The pain is aggravated by coughing and by dee]} 
inspiration. 

With the first appearance of symptoms there is a rapid rise in the tem- 
perature, great heat of skin, together with headache, loss of appetite, 
thirst, and prostration. The respiration is increased in frequency, often 
to a marked degree, and the breathing is difficult; there is a short, hacking 
cough, the countenance is flushed and anxious, the pulse is accelerated, and 
in character full and hard. The respiration in this disease has been 
described by some as panting, the expiration as moaning. The difficulty 
in breathing is not measured by the amount of lung involved, but rather 
by the nervous prostration. 

The cough is at first attended with but scanty expectoration, thick, 
transparent, and purely catarrhal. This soon changes, and exhibits char- 
acteristic peculiarities. It becomes semi-transparent, thick, tenacious, and 
has a reddish tint, like that of iron-rust ; hence it is commonly known as 
the "rusty" sputa. It is so adhesive that "the cup containing it may be 
inverted without spilling the mass." The color is due to the presence of 
blood. When the sputa contain blood in abundance, and of a dark color, 
it is called the prune-juice expectoration, and is indicative often of a 
depraved state of the system. In about ten per cent only of the cases of 
pneumonia is cough absent. 

During the second stage the pain subsides, or ceases altogether. The 
cough becomes less distressing, and expectoration more abundant and 
easier, the sputa being less tenacious. Its color changes, and assumes the 
appearance of that seen in bronchitis. The fever continues, but is less 
intense. The pulse ranges from ninety to one hundred and twenty, and, 
as a rule, increases somewhat in rapidity from the beginning of the 
attack; this acceleration continues until the fever subsides. In this stage 
an herpetic eruption appears in many cases on the cheeks, nose, lips, or 
eyelids. 

During the third stage, that of resolution, the symptoms denote j^rogrt-s- 
sive improvement. The fever subsides, and finally ceases. The breathing 



ACUTE PNEUMONIA. 209 

is less hurried, and then becomes natural. The cough is no longer trouble- 
some, and eventually disappears. The appetite returns, the strength 
improves, and recovery has commenced. If, however, the disease passes 
into the stage of suppuration or purulent infiltration, the fever persists, 
and the general symptoms indicate an unfavorable course. There is 
greater prostration, the expectoration becomes profuse and purulent, and 
the respiration hurried. Often the symptoms are typhoidal, the tongue 
brown and dry ; dark deposits appear on the teeth ; sleeplessness and 
delirium are not infrequently noted in this stage. 

In most cases of acute pneumonia there appears on the face the so- 
called "pneumonic spot." It is a dusky redness of one or both cheeks, 
and when noted in previously healthy subjects it is strongly indicative of 
the presence of the disease in question. Headache usually occurs early in 
the disease, and may be present throughout, but more often lessens after 
the third day. Delirium and convulsions are not infrequently met with in 
patients of intemperate habits, whose systems have been shattered by 
excessive indulgence in alcohol. Occasionally delirium is due to other 
causes, often to the febrile disturbance. It is more frequent when the 
upper lobe of the lung is affected, and may be mild or violent. 

Causation. Pneumonia is an infectious disease ; it is epidemic, and 
occurs more frequently at certain seasons of the year. Among its causes 
may be properly considered bad hygienic surroundings. It is probably 
due to a germ, either in the air or water. The disease appears at all 
periods of the year, but in March, April, and May it is the most common. 
Men are more liable to attacks than women, and the poor and ill fed than the 
rich and well nourished. Persons who lead mostly an outdoor life suffer 
less from pneumonia than those engaged in sedentary pursuits. It is more 
often seen in the weak and debilitated ; drunkards are especially predis- 
posed to the affection. It is generally accepted that patients who have 
suffered one attack are more liable to experience another. Pneumonia 
does not arise from catching cold. 

Diagnosis. In acute pneumonia, among the symptoms already described 
there are some which are highly distinctive of the affection. If a patient 
is seized with a chill, followed by fever and an attack of pain near the 
nipple, and there is noted the characteristic rusty expectoration, then the 
diagnosis is readily made. When these symptoms are absent, or insuf- 
ficiently pronounced, the physical signs will be of some assistance to the 
layman, but to correctly interpret all that appear will need a practical skill 
which cannot be acquired except at the bedside of the patient. 

During the first stage, the movements of the affected side of the chest 
are more or less restricted. By auscultation there are detected the so- 
called "crepitant rales" They are dry, very fine, crackling sounds, heard 
only with inspiration. They resemble those produced by throwing salt on 
hot coals, or rubbing the hair between the fingers. These sounds are 



-10 DISEASES OF THE RESPIRATORY SYSTEM. 

almost pathognomonic of pneumonia. In the second stage, percussion 
shows a marked dulness over that portion of the lung affected. In the 
same situation, by auscultation is noted the so-called bronchial respiration, 
similar in character to that which is heard when the ear is placed on the side 
of the neck. During the third stage of the disease, if it runs a favorable 
course, the dulness on percussion becomes less evident, and there is apparent 
to the ear a moist, tine, bubbling sound, heard with either inspiration or 
expiration. The physical signs described are among the many which are 
present in pneumonia; there are others, which to describe herein would be 
purposeless and confusing. 

l J ro<jno$is. Acute pneumonia, uncomplicated, and confined to a single 
lobe, in a patient having a fairly good constitution, tends to recovery. 
According to one author, the prognosis depends more on the age than on 
any other single element. In infancy the mortality is greater than in child- 
hood. Between the ages of forty and sixty, the death-rate is from ten to 
twenty-five per cent, while from ten to thirty years, almost all the uncom- 
plicated cases recover. After sixty, the prognosis is always unfavorable. 
The symptoms described by Flint as unfavorable as prognostics are the 
following: frequency and feebleness of the pulse; great frequency and 
labor of respiration ; lividity of the lips and face ; an abundant purulent 
or muco-purulent expectoration ; bloody, dark-colored sputa, commonly 
known as the prune-juice expectoration; active, violent delirium; low, 
muttering delirium, with prostration and picking at the bedclothes, constitu- 
ting the typhoid state. It may be said that a gradual rise in temperature 
after the fourth day is an unfavorable indication. When the expectoration 
is absent or very scanty in the second or third stages, also when it is frothy 
in character, the danger is greater. Pneumonia is a bad complication with 
kidney disease, and among steady drinkers the fatality is great. 

Treatment. It may properly be said that, if the patients previous to 
the attack were in good health, they require no special treatment, except 
as special symptoms appear. Many complain of pain, cough, and inability 
to sleep. An opiate is then extremely useful, and ten grains of Dover's 
powder, or one-eighth of a grain of morphine, should be given every 
five or six hours, as needed. If constipation exists, rhubarb, magnesia, 
Hunyadi water, or Rochelle salts, may be administered. If the fever runs 
high, a mixture of the solution of acetate of ammonia and sweet spirit of 
nitre, three ounces of the former to one of the latter, given in tablespoonful 
doses, well diluted, will cause perspiration. External applications in pneu- 
monia are of no value. Poultices, formerly in such repute, are no longer 
employed. Glazed cotton wadding pinned around the chest gives a sensa- 
tion of warmth, and meets all requirements. If there is much pain, a weak 
mustard paste can be used. It should be made of one part mustard to two 
parts Indian meal, mixed with cold water, and should be kept on until the 
skin is reddened. 



PLEURODYNIA AND INTERCOSTAL NEURALGIA. 211 

If the patient under treatment is accustomed to the use of alcohol, 
spirits must be allowed ; otherwise they should not be given, except when 
signs of exhaustion are noted. Ordinarily, if stimulants are needed by tem- 
perate patients, the carbonate of ammonia, in from five to ten grain doses, 
given every three or four hours, will be the most useful. The diet should 
be milk, wine-whey, beef-tea, beef-juice, and soft, liquid foods, such :is cus- 
tards, gruels, etc. As the temperature falls, the appetite returns, and then 
a more nutritious diet will be demanded; solid and substantial food can be 
allowed as soon as convalescence is assured. 



PLEURODYNIA AND INTERCOSTAL NEURALGIA. 

The term pleurodynia is applied to a painful affection of the muscles 
which are attached to the ribs. It is rheumatic in character, and is attended 
with many of the symptoms of acute pleurisy. There is pain in the side, 
which is increased by the respiratory movements, and a patient suffering 
from it leans to the affected side. In pleurodynia there may be some fever, 
and there is often a dry cough. Intercostal neuralgia, as the name implies, 
is a neuralgic affection of the nerves distributed over the walls of the 
chest. As regards pain, it is liable to be confounded with either acute 
pneumonia or pleuritis. As a rule, it is more or less dull and persistent, 
but occasionally the pain is tearing, stabbing, and burning. All respira- 
tory movements increase it, as does also pressure on the skin. During an 
attack the patient assumes the same position as in pleuritis, and wears a 
disturbed, anxious expression, fearing to breathe deeply or speak loudly. 
This affection is rarely, if ever, accompanied with fever. Its diagnosis 
depends on the discovery of the so-called characteristic painful p>oints. 
First, there is one near the spinal column ; a second on the side, between the 
ribs; a third in front, over the pit of the stomach. These points mark the 
course of the nerve, and are usually extremely sensitive to pressure. The 
affection occurs oftener on the left side than on the right. 

In pleurodynia the pain is not limited to isolated points, but is more 
or less diffused over the affected side. , To distinguish this affection from 
intercostal neuralgia is not always easy, and a careful examination is 
necessary. To discriminate between either of these and pneumonia or 
pleuritis will be less difficult. Angina pecto?*is resembles intercostal 
neuralgia in many respects, but the suffering is more intense, the anxiety 
greater, and there is a feeling of threatened suffocation and impending 
death. To these may be added the peculiar changes presented by the 
heart and pulse. 

In the treatment of these affections, to relieve pain, if that be severe, 
is the first essential. Opiates will be demanded, and one grain of opium 
may be given internally, or one-eighth of a grain of morphine hypoder- 
mically. If the pain is but slight, a belladonna plaster, six by seven inches 



212 DISEASES OF THE RESPIRATORY SYSTEM. 

square, will ordinarily suffice. Intercostal neuralgia is more often com- 
plained of by women, and is associated with other constitutional disturb- 
ances. When the affection exists, the habits and the general condition of 
the patient should be carefully studied, and the treatment directed to the 
removal of all eo-existing conditions producing irritation or debility. 
Iron, quinine, cod-liver oil, or other tonics, together with supportive and 
hygienic measures, should be employed, as their need is apparent. 



CHAPTER III. 
PULMONARY CONSUMPTION. 

Consumption of the lungs, or, as it is variously termed, pulmonary 
phthisis and pulmonary tuberculosis, is essentially a chronic disease, char- 
acterized by a consolidation and ulceration of the lung-substance. The 
term tubercle signifies a small nodule, and in nearly all cases of pulmonary 
consumption there are formed in the lungs tuberculous nodules, visible to 
the naked eye, or small granules of a similar nature, apparent under the 
microscope. The morbid changes which characterize the formation of 
tubercle generally occur first in the upper lobes of the lungs, and slowly 
or rapidly extend, affecting all the structures which enter into their 
formation. 

After a period, varying much in different cases, cavities are formed in 
the lungs, more often due to ulcerative processes, induced by a softening of 
the morbid deposits. Cavities are also formed by dilatation of the smaller 
air-passages, induced by the same diseased changes. As ulceration extends, 
tissues before it are destroyed, and often small arteries are opened, giving 
rise to more or less severe hemorrhage. 

Symjrtoms. Pulmonary consumption is an affection which comes on 
insidiously, and may for a long period give no distinctive signs. Bodily 
weakness, loss of weight, pallor, and night sweats are usually among the 
earlier manifestations. Some cases begin with digestive disturbances, dys- 
pepsia, irregularity of the bowels, and often constipation. One of the 
earliest and most constant symptoms is cough. At first it is dry and hack- 
ing, and there is little or no expectoration. In occasional instances, bleeding 
from the lungs is the first evidence indicative of their diseased condition. 
Other cases begin very like typhoid fever. Pain in the chest is often suf- 
fered, but it is not in itself characteristic of consumption. An important 
sign is quickening of the pulse ; the increase in its rapidity is not great at 
first, but it invariably rises above the normal as soon as the morbid changes 
commence in the lungs. As the disease progresses, the temperature of the 
body is raised ; the thermometer is, therefore, of great assistance in diag- 
nosticating doubtful cases. Chills sometimes occur, and fever usually 
comes on every evening. 

213 



214 DISEASES OF THE RESPIRATORY SYSTEM. 

The nutritive processes suffer early impairment, and the loss of weight 
continues as long as the disease is progressive. Muscular strength dimin- 
ishes in all eases, but in some the loss is more rapid than in others. A nota- 
ble peculiarity in patients suffering with consumption is their cheerfulness 
and buoyancy. They depreciate their symptoms, and often obstinately refuse 
to believe themselves affected with a serious malady. Hope of recovery 
is maintained even to the last stages of the disease, although the decline is 
notably great and rapid. 

The respiration is more or less accelerated, and exertion is attended with 
difficult breathing. The symptoms referable to the digestive organs are 
generally pronounced ; loss of appetite is often one of the first. Digestion 
becomes impaired, and diarrhoea is not uncommon; it may occur in any 
stage, but is more frequent in the advanced. Hoarseness, and even loss 
of voice, denotes laryngitis, which is a usual accompaniment of the disease 
under consideration. 

After cavities are formed, the second stage is entered, and the symptoms 
become more pronounced. The cough, less irritable, is more prominent, 
and the expectoration more profuse. The sputa are muco-purulent, and 
assume more or less the appearance of pus. Often small particles resem- 
bling boiled rice are raised. Hemorrhage occurs less frequently after this 
stage of the disease is reached than in the first. Sometimes the loss of 
blood is sufficient to destroy life, but instances are rare. The writer recalls 
one case, in hospital practice, in which death resulted within a few 
moments from sudden and great hemorrhage. 

As the disease progresses, emaciation is more rapid ; the fever runs 
higher, and is more often present. Circulation fails, and swelling of the 
feet and ankles appears in consequence. Rarely are patients long confined 
to the bed ; not infrequently sufficient strength is preserved to allow them 
to be up much of the time, and even to be out of doors within a few days 
of death. 

Bulbous enlargement of the ends of the fingers, with an inward curv- 
ing of the nails, forming what is called "clubbed fingers," is frequently 
observed. This peculiar appearance is characteristic of serious chronic 
pulmonary affections, but is not pathognomonic as it occurs in organic 
diseases of the heart. This symptom is said to appear in about one-fourth 
of the cases of consumption. 

This malady is attended w T ith complications, and other affections 
almost invariably co-exist. Tubercular disease of the intestines, larynx, and 
pleura, and pleuritis are associated. Chronic peritonitis is an occasional 
complication. Xearly all the important organs of the body take on 
degenerative changes. These affections measurably influence the course 
of the disease, and its duration is extremely variable. In some cases, the 
softening and ulceration are rapidly progressive, and cavities soon form ; in 
others, the disease is retarded for months, and even for years in excep- 
tional cases. 



PULMONARY CONSUMPTION. 215 

Causation. It is said th.it everything which appears to affect the 
health of mankind has been alleged to be a cause of pulmonary consump- 
tion, such as deficiency and poor quality of food, lack of pure air, light, 
warmth, and exercise ; in fact, everything which impairs the nourishment 
of the body, induces poverty of the blood, or depresses the nervous 
system. In estimating the causes, it is necessary to consider certain 
conditions of the system which predispose to this disease, or which act 
with those already assigned. That a tendency or liability to pulmonary 
consumption is transmitted by inheritance is well known. Delicacy of 
constitution, peculiar to the whole system or to different parts, either 
inherited or acquired, may be numbered with the predisposing causes. So, 
also, may occupation, mode of life, and many other similar influences. 
Very many inflammatory diseases of the lung itself, especially those of a 
catarrhal type, and other affections, prominent among which are measles 
and whooping-cough, create a liability to pulmonary consumption. 
Among other exciting causes are impure air, insufficient and unwholesome 
diet, excessive indulgences, overwork, and prolonged nursing. The living 
germ, known as bacillus, is present in every case of the disease in question. 
This fact, determined by recent research, while of considerable importance, 
is yet but the mere foundation of a crude theory, to perfect which years 
of patient investigation will be needed. It is believed by some that con- 
sumption is a contagious disease ; many arguments are brought to sustain, 
and as many to refute this assumption. Practically, nothing is yet known 
on the subject. 

Diagnosis. During the first stage of pulmonary consumption the 
physical signs are not invariably well marked, and a trained ear is 
essential to detect on auscultation and percussion the sometimes exceed- 
ingly slight variations from the normal sounds. In the second stage, the 
characteristic sounds are more apparent. Their discussion here is 
scarcely necessary, however, as the symptoms already described, and to be 
again referred to, will be quite sufficient to point to the existence of this 
serious malady, and a physician must be consulted to confirm or disprove 
the diagnosis. 

The important indications to be considered are cough (at first dry, 
and afterwards attended with an expectoration), pain at the top of the 
chest, chills, acceleration of the pulse, fever, hemorrhage, shortness of 
breath, sweats at night, hoarseness, loss of weight and strength, and 
buoyancy of spirit instead of depression, as would ordinarily be associated 
with these symptoms. The history of the patient must also be considered, 
and due weight be given the fact if it is determined that there is a family 
tendency to consumption. It will often be difficult to discriminate between 
this disease and chronic bronchitis. It should be remembered that the 
latter affection is very rare except in aged persons and those suffering 
from disease of the heart. Too much significance cannot be attached to 



216 DIS] - - OF THE KESriEA SYSTEM. 

hemorrhage from the lungs. It ifl _ symptom, which must nut l^e 

notwithstanding the fact that it sometimes occurs in other 
affections of the loi gs, 

Pulmonary consumption is always a very grave disease, but 
ssarily fatal in all cases. sionally the malady is arrested and 
exists for a long time in a latent form, and in - 

s to take place. The age of the patient affected is an important 
consideration. After thirty-five years the disc sc usn ally progresses much 
more slowly, and is long protracic d. In reaching a prognosis, the previous 
health of the patient, his means, aud his docility must be duly weighed. 
It should be remembered that nearly, if not quite all, suffering from this 
- hopeful of recovery, and are so slow to realize their exceed- 
ing danger, many of their chances of life are wasted by this insane delu- 
sion. Probably no class of patients fall so easily into the toils of quacks 
; iisumptives. Thus it will be seen that the mental state is an impor- 
tant consideration in estimating the chances of recov- 

A marked hereditary tendency does not always mean rapid death : the 
same may be said of repeated and even profuse hemorrhages. Pre _ — 
emaciation and laryngeal affections are discouraging symptoms. The 
appetite, in many cases, fails, and, unless it can be renewed, the progno— is 
grave. The average duration of pulmonary consumption is from one to 
three years. In estimating the probable lease of life in individual cases, 
the effect of treatment, change in habits, occupation, climate, etc., must all 
be considered. 

Treatment. Measures are to be employed to improve the general health, 
the condition of the lungs of the patient, and to combat the complica:: m 
of the disease. In the early stage, while the malady is but slowly pro- 
_ *ss i re, treatment promises the best results. It must be remembered that 
two years at least will be needed to effect a radical improvement. All 
improper habits must be corrected, outdoor life lived, and healthy surround- 
ings sought. The beneficent effects of a change in climate in the treatment 
of consumption are unquestioned. 

■ An ideal health-resort for this disease," b . Dr. Harold Williams, 
'•should be sparsely and newly settled. It should xssess are :\ter- 

supply and adequate drainage. It should be of a dry and porous soil, and 
should be favorably situated with respect to neighboring heights and 
marshes, and prevailing winds. It should be equable in temperature, and 
should possess the maximum of pleasant weather. It should not be so hot 
as to be enervating, nor so cold as to prevent outdoor exercise and proper 
ventilation of the houses. It should afford plenty of amusement ; it should 
not be crowded with consumptives ; and it should be sufficiently unfash- 
ionable as to admit of hygienic dress. Above all, it should afford suitable 
accommodations for the invalid. The house should be carefully 
and thoroughly ventilated ; the food shoidd be abundant, palatable, and 



PULMONARY CONSUMPTION. 217 

varied; and the sleeping-room should be large and sunny, and afford 
sufficient ventilation. I believe that such a health-resort as affords these 
advantages in the highest degree will be found by experience to be the best 
locality for a phthisical patient, be the barometric pressure, the aqueous 
vapor, and 'the diathermancy' what they may." 

A habit of not little importance to acquire is that of freely inflating 
the lungs by deep inspirations. Daily sponge-baths, cold water being, if 
possible, employed, assist in improving the general health. With other 
nutritious foods, milk and cream are important essentials. Alcohol in some 
form should enter into the treatment of consumptives ; malt liquors are to 
be given the preference. The medicinal remedy which promises the best 
results in this disease is cod-liver oil. Patients should commence with one 
teaspoonful three times daily, and gradually increase the quantity as they 
become accustomed to its use. This agent is to many at first extremely 
disagreeable, but its taste is absolutely disguised in the froth of beer. 
Glycerine may be substituted when the oil cannot be taken, or it may be 
used at the same time. Glycerine and whiskey form an admirable mixture 
to relieve the cough. Of recognized virtue is the compound syrup of hypo- 
phosphites, an agent from the use of which excellent results have been 
obtained in the incipient stages of this disease. 

The night-sweats in pulmonary consumjjtion are exhausting, and a 
source of great discomfort. The remedy which is most active in con- 
trolling them is atropine. Granules, each containing about one-seventieth 
of a grain, are kept by druggists. One should be taken at bedtime. If 
these pills cannot be obtained, ten drops of the tincture of belladonna will 
usually prove efficacious. Diarrhoea is often difficult to control; when it 
exists, the subnitrate of bismuth and Dover's powder, each ten grains, 
should be given every six or eight hours, as needed. In such cases the 
diet must be restricted to the most bland and easily digestible of foods. 
Hot applications to the abdomen assist in the treatment. 

Hemorrhage from the lungs is a symptom which excites the greatest 
apprehension, not only in the patient but in friends. It should be remem- 
bered that it is not only rarely fatal, but, also, that it invariably brings 
a measure of relief from the cough and the distressing constricted sensa- 
tions previously felt in the chest. Many remedies are advised for this 
emergency, but rest and opium are the most valuable. One grain of opium, 
or twenty-five drops of laudanum, should be given at once, and repeated 
in from four to six hours. The patient must be kept perfectly quiet, and 
not allowed to speak. His fears are best subdued by the force of example, 
and his friends must appreciate this fact and conduct themselves accord- 
ingly. Rest in bed should be enforced for three or four days after the 
hemorrhage has ceased. 

Complications constantly arise during the advanced stages of pulmonary 
consumption. The indications in each instance will determine the proper 



218 DISEASES OF THE KESPIRATOKY SYSTEM. 

treatment to employ. While the contagiousness of this disease is yet a 
disputed question, and nothing definite is really known, it is well for 
relatives and attendants to assume that the affirmative theory is correct. 
The sick-room should be large, always well ventilated, and, during the 
night, allotted to the sole use of the patient. Under no condition 
should another share with him the same bed, after the nature of the 
disease is determined. 



ACUTE PULMONARY CONSUMPTION. 

Acute pulmonary consumption, or, as it is termed, acute phthisis, 
galloping or quick consumption, is a disease which usually occurs in young 
subjects, and is characterized by a comparatively sudden invasion and brief 
and rapid course. The essential distinction between this affection and 
chronic pulmonary consumption is in the duration and the intensity of 
symptoms, many of which exhibited in the acute are also common to the 
chronic form. 

Various causes have been assigned for this disease, based on assumption 
and speculative reasoning, rather than determined by absolute knowledge. 
A condition of the system characterized by defective nutrition, associated 
with the so-called scrofulous jn-edisposition, invites the disease. This 
malady is more often met with in the young who have grown rapidly, 
and who have a strong inherited consumptive taint. Children who have 
been nursed by consumptive mothers are especially liable to its develop- 
ment. 

The symptoms of the acute are, as stated, those of the chronic form 
intensified. A young ]3atient who has had for some time a dry, hacking 
cough, attended with a steady loss of flesh, is suddenly seized with, a sharp 
pain in the side. The pulse becomes rapid and feeble ; the fever runs high at 
night, broken by chills and profuse sweats, the temperature falling to near 
the normal toward morning. The cough is soon attended with a j>i*ofuse 
purulent expectoration ; emaciation and loss of strength are rapid. 
Respiration becomes quickened and difficult ; nausea, vomiting, and 
diarrhoea are often prominent symptoms. Early in the attack the desire 
for food is almost, if not entirely, lost. The blood soon becomes impov- 
erished, and the skin assumes a pearly pallor; a hectic flush is present, and 
the eyes are bright and glistening. Hemorrhage frequently occurs, and is 
rarely absent during the course of the disease. All vital forces decline 
rapidly ; the exhaustion is steadily progressive, and only in rare instances 
is the disease arrested, or is there evident improvement. 

The prognosis in this disease is always unfavorable. The average dura- 
tion is from one to five months. Death may occur from exhaustion or 
complications. Those affections which are so frequently associated with 
chronic consumption also co-exist with the acute form of the disease. 



ACUTE PULMONAEY CONSUMPTION. 219 

As almost all cases are hopeless, the treatment is necessarily limited 
to measures which prolong life and keep the patient comfortable. Of 
medicinal remedies opiates promise the best results. If nausea and vomiting 
exist, it will be necessary to give morphine hypodermically ; generally, 
small doses, repeated every six or eight hours, will control the patient's 
suffering. 



CHAPTER IV. 

BRONCHITIS. 

Inflammation seated in the lining membrane of the bronchial tubes 
constitutes the disease called bronchitis. It seldom occurs as an isolated 
affection ; the mucous membrane lining the throat and larynx is, as a rule. 
simultaneously affected. Bronchitis varies in extent, intensity, and dura- 
tion. Thus, it may be limited to the larger bronchial tubes, or it may 
extend into the smaller and so-called capillary tubes. It may be mild or 
severe in character, run a rapid course or be indefinitely protracted. 
There are several varieties of this disease, based on these differences as 
regards duration and degree of the inflammation. It is sufficient in this 
work to discriminate between three principal forms, capillary > chronic, 
and acute bronchitis. 



ACUTE BRONCHITIS. 

Acute bronchitis is an inflammation of the mucous membrane of the 
larger bronchial tubes. It rarely originates in the tubes themselves, but is 
generally an extension of a similar inflammation affecting the mucous 
membrane of the nose and throat. The membrane is swollen and reddened, 
either uniformly or in patches, and its natural secretion is lessened or 
entirely absent for a certain period, which constitutes the first or so-called 
dry stage. After a time, the secretion becomes copious, and, as a rule, 
consists principally of the elements of the normal secretion of the mucous 
membrane, in increased quantity. If, however, the irritation is unusually 
intense, or the affection is of long continuance, to the natural secretion is 
added pus, in more or less abundance. 

Acute bronchial inflammation, involving only the larger tubes, occurs at 
all ages, but in childhood and old age the smaller or capillary tubes are 
most frequently invaded. It is a bilateral disease, the tubes on both sides 
being equally affected. 

Symptoms. Acute bronchitis is what is usually regarded as a common 
"cold." An attack is generally preceded by inflammation of the mucous 
membrane of the nasal passages, or coryza, which travels downward, 

220 



ACUTE BRONCHITIS. 221 

usually affecting the pharynx and larynx in its passage to the bronchial 
tubes. The invasion is rarely accompanied with a distinct chill, but often 
with chilly sensations followed by flashes of heat. Sore throat and 
hoarseness are frequently early manifestations, and when the inflammation 
reaches the bronchial tubes it gives rise to a sense of tightness and of sore- 
ness or rawness in the chest. These painful sensations are especially aggra- 
vated by the cough, which is at first dry, hacking, and often incessant. 

The general febrile symptoms are usually mild in character, and the 
pulse is but slightly increased in frequency. The appetite lessens, but is 
rarely absent ; there is some loss of strength, and a general disinclination 
to active movement. Patients generally complain of a dull, aching pain 
in the back and limbs. As a rule, in acute bronchitis there is no impedi- 
ment whatever to respiration. In cases of unusual severity, or those run- 
ning a protracted course, there is not infrequently a difficulty in breathing, 
characterized by a relatively normal inspiration, with a markedly prolonged 
and impeded expiration. 

The cough is at first dry, and attended with but scanty expectoration. 
It is especially distressing on lying down, and often assumes a paroxysmal 
character. Occasionally the sputa are streaked with blood. The dry stage 
passes in from one to three days ; the cough then becomes loose and the 
expectoration abundant. It at first consists of frothy mucus, of a yellowish 
or greenish color and a salty taste; then, gradually, it becomes muco-puru- 
lent, and sometimes purulent. As soon as easy expectoration is established, 
the patient is at once relieved ; pain and soreness disappear, and conva- 
lescence is usually rapid. 

Causation. Many predisposing causes to acute bronchitis may be 
assigned. Among them are included delicacy of physical constitution, 
natural or acquired in consequence of debilitating diseases of long continu- 
ance ; occupation, habits, age, and hygienic surroundings. The affection 
is comparatively rare in climates of equable temperature, be they continu- 
ously hot or cold. The season of the year is, in a measure, influential ; 
in the northern part of America the disease prevails most in spring and 
fall. It occurs secondarily in connection with disturbances of circulation, 
and is frequently noted in diseases of the heart and kidneys. In affections 
characterized by specific blood-changes, such as measles, typhoid and typhus 
fevers, gout, rheumatism, etc., it commonly exists as a complication. 

Acute bronchitis is often associated with other pulmonary diseases ; it 
may also occur traumatically, by the inhalation of irritating gases, parti- 
cles of dust, certain peculiar emanations, etc. At times it prevails in 
epidemics ; it is then commonly known as influenza, and is due to some 
unknown special atmospheric influence. The liability to the disease bears 
a relation proportionate to the general vigor of the constitution. As a 
rule, those who are habituated to exposure are less disposed to the disease 
than those accustomed to indoor life. 



___ DISEASES OF THE RESPIRATORY SYSTEM. 

The most important exciting cause is the action of cold, causing a chill- 
ing of the surface of the body. This injurious influence is naturally 
greatest in times of sudden changes in the weather, and when the same is 
moist and cold. By too severe and sudden cooling of the body, the func- 
tions of the skin are interrupted; an increased duty is thereby thrown 
upon the pulmonary mucous membrane, and congestion induced. 

Diagnosis, To discriminate between acute bronchitis and other pul- 
monary affections should be easy. The manner of its invasion and the 
symptoms which precede the attack, the bronchial character of the cough 
and expectoration, are sufficiently distinctive. The physical signs indica- 
tive of the affection are only determinable on auscultation. Bubbling 
sounds may, in the second stage, be heard on both sides, over the 
whole chest, due to the presence of mucus in the bronchial tubes of 
larger size. Sometimes they are heard just after a fit of coughing, when at 
no other time. 

Prognosis. Acute bronchitis, uncomplicated with other diseases, unless 
it occurs in the very young, aged, or feeble, never directly destroys life. 
Its average duration is ten or twelve days, and it ends in complete recov- 
ery or in chronic bronchitis. The disease has no tendency to induce either 
pleurisy or acute lobar pneumonia, and rarely does it precede the develop- 
ment of pulmonary consumption. 

Treatment. Acute bronchitis can in many instances be prevented, if 
treatment is instituted while the inflammation is confined to the nasal pas- 
sages. At the onset, ten grains of Dover's powder should be given at bed- 
time, accompanied with a hot foot-bath, and followed in the morning by a 
brisk saline purgative. If these measures do not abort the attack, they 
will at least materially lessen its intensity and shorten the course. If chilly 
sensations are experienced, accompanied with aching pains in the back and 
limbs, twenty grains of quinine will be found a very efficient abortive 
remedy, and should be given at night, after the hot bath. The Russian or 
Turkish baths are also effective, if exceeding care is used against exposure 
after taking them. 

If bronchitis becomes established, and the attack is severe, the patient 
should be subjected to proper restrictions in diet, and confined in bed for a 
few days, in a room well ventilated and kept at an equable temperature. 
If the pain and soreness in the chest are considerable, mustard poultices 
should be applied twice a day, left on fifteen minutes, and replaced with 
flannel. Opiates in many cases will be demanded, and may be properly 
combined with expectorants as follows : — 

^ Pulv. scillse gr. viij. 

Pulv. ipecac gr. ij. 

Pulv. opii gr. v. 

Ft. pil. Xo. viij. Sig. : Dose, one pill, from four to six hours. 



CAPILLARY BRONCHITIS. 223 

In some patients opium in any form causes discomfort, and is not well 
borne. In such cases the following mixture should be substituted : — 

fy Syr. scillaj 5 j. 

Spt. setheris comp % ]. 

Syr. tolu 5 ij- 

Ft. mist. Sig. : Shake well. Dose, two teaspoonfuls in a wine-glass of water, 
every three or four hours. 

If acute bronchitis does not yield readily, and threatens to pass into the 
chronic form, tonic remedies are indicated ; quinine in three-grain doses, 
three times a day, may be administered. A nutritious diet, together with 
other restorative measures, should be added to the treatment. 



CAPILLARY BRONCHITIS. 

When acute inflammation invades the bronchial tubes of small size, it 
is termed capillary bronchitis. In most cases, this form is an extension of 
simple bronchitis affecting the larger tubes. It is an exceedingly grave 
affection, occurring more often in young children and in the aged ; it 
is occasionally met with in adults. The mucous membrane becomes 
reddened and swollen, and the tubes, more or less filled with the abnormal 
secretion, are obstructed, and the free passage of air is interrupted during 
the respiratory acts. Not only is the easy entrance of air into the air-cells 
denied, but its expulsion is equally, if not more, difficult ; it accumulates 
within them and dilatation results. In some instances the plugging of the 
tubes is complete, and leads to collapse of the connecting air-spaces. 

Capillary bronchitis is usually preceded by inflammation of the larger 
tubes, and the symptoms of invasion are characteristic of the simple acute 
bronchitis. When the smaller tubes become involved, difficult and 
labored respiration gives evidence of the fact. The patient is usually 
unable to lie down, and maintains a sitting position, suffering exceedingly 
for the want of breath. His countenance is swollen, flushed, and anxious, 
plainly indicating his great distress, the nostrils dilate, and speech is short 
and jerking. The respirations are usually increased in proportion to the 
severity of the disease ; in young children they sometimes reach sixty and 
seventy in a minute. The pulse is feeble and rapid ; in the beginning of 
the attack, the temperature rises four or five degrees, but usually falls as 
the disease advances. Cough is more or less prominent from the 
commencement, being short, hacking, and incessant. It is difficult and 
ineffectual for the want of breath, and adds much to the patient's suffering. 
There is little expectoration at first; later, it becomes more abundant. 
When the sputa are put in water, they present characteristic appearances: 
the frothy mucus floats, and is connected by filaments with heavier masses, 
which sink below the surface. The former, expelled from the larger tubes, 



224 DISEASES (^V THE RESPIRATORY SYSTEM. 

is thin, and contains air: the latter, viscid and tough, preserves the form of 
the smaller tubes, from which it is thrown. 

As the disease progresses, in consequence of imperfect oxygenation of 
the blood, the face becomes livid, the lips blue, blood settles under the 
finger-nails, and the veins of the neck are swollen and distended. There 
is great restlessness, and the patient grow 7 s rapidly weaker. Respiration 
grows more difficult, and signs of impending suffocation are plainly 
evident. A profuse, cold, clammy sweat covers the body, the extremities 
become cold, the pulse small and thready, the sufferer no longer fights so 
painfully for breath, his respirations are less frequent, he mutters deliriously, 
becomes partially or completely unconscious, his cough ceases, and he dies 
from suffocation. 

The symptoms described vary somewhat with the age and peculiarities 
of the individual affected. In all cases they will be sufficiently distinctive 
to render it impossible to confound capillary with ordinary bronchitis. 
Pneumonia and asthma are the diseases characterized by symptoms 
resembling somewdiat those of capillary bronchitis; but, after a careful 
study of the signs of each, discrimination should be easy. The duration 
of the disease under consideration is usually from three to five days; 
cases are on record which terminated fatally in less than twelve hours. 
It is not impossible for recovery to take place ; patients who survive are, 
in nearly all instances, adults. 

In a disease of such exceeding gravity, to merely outline the treatment 
will suffice. On the first appearance of the symptoms, steam should be 
generated, and the air of the room loaded with moisture, to facilitate expec- 
toration and relieve the difficult breathing. The rapidly exhausting charac- 
ter of the affection should be remembered, and sustaining measures be 
employed from the first. Tonics will be needed as the disease advances. 
For medicinal treatment the following mixture promises the best 
results : — 

J£ Ammonise muriatis 5 ss - 

Potass, chloratis 3 iij. 

Aqua? 5 xr J« 

Ft. mist. Sig. : Dose, one tablespoonful, every two hours. 

Opiates should never be administered in capillary bronchitis. Under 
the influence of such agents, struggling patients no longer fight heroically 
for breath and life; their efforts relax, suffocation overtakes them, and 
death follows. 

CHRONIC BRONCHITIS. 

Chronic bronchitis is a very common disease, which occurs much 
oftener in aged persons than during the early and middle period of life. 
It may be either a primary or secondary affection. It is deemed the former 



CHRONIC BRONCHITIS. 225 

when it results from exposure to wet and cold, or is excited by the con- 
stant inhalation of dust, vapors, or other irritating substances. It occurs 
secondarily in many chronic diseases of the lungs, in chronic affections 
located elsewhere, and in certain severe constitutional disturbances due to 
infection, loss of blood, and the like. It is a frequent complication in dis- 
eases of the heart and kidneys. 

Chronic bronchitis is frequently developed from the acute, but often it 
comes on so stealthily its commencing stage is not recognized. One 
author says : "Bronchial irritation may exist perhaps for years as the result 
of some mechanical irritation (as in the case of stone-cutters, grain-heavers, 
etc.), and not particularly inconvenience the individual until an acute 
catarrh is developed from exposure; this invariably becomes chronic, and, 
sooner or later, leads to the development of broncho-pneumonia, and a con- 
dition called knife-grinders' or stone-cutters' phthisis follows." 

The symptoms of chronic bronchitis coincide in all essential points 
with those of the acute form, differing only in intensity, and augmented by 
others proceeding from associated affections. More or less cough always 
exists. If the disease comes on slowly, it is, for a time, only in the morn- 
ing, after waking, that the patient experiences a decided disposition to 
cough. This symptom gradually becomes more prominent, varying in 
frequency and severity in different cases. If a mild form of the disease is 
suffered from, a moderate degree of cough is repeated from time to time 
during the day, and expectoration is always followed by relief. In more 
severe and farther advanced forms, on the contrary, the disposition to cough 
persists almost continuously, and the patient is annoyed more or less day 
and night. After a time he complains of shortness of breath, especially on 
unusual exertion ; palpitation of the heart is also added to his discomfort. 

The expectoration varies much in different cases. It is sometimes 
abundant, consisting largely of mucus ; generally it is muco-purulent, and 
of a yellowish color. In occasional instances, it consists of large, thick, 
greenish sputa. When the expectoration is copious and easy, the cough is 
less distressing; when it is scanty, the effort to free the lungs is paroxys- 
mal, and often excites vomiting. The odor of the sputa also varies; some- 
times it is sweet and nauseous ; at other times it is exceedingly offensive, 
and the affection is then the so-called fetid bronchitis. There is a variety 
of chronic bronchitis, not infrequently observed in old people, in which th<3 
expectoration often amounts to several pints in twenty-four hours ; in such 
cases it is either watery and transparent, or ropy, resembling a mixture 
of the white of egg and water. 

In uncomplicated chronic bronchitis pain is generally wanting. There 
is little or no fever; the pulse does not exceed the normal frequency; the 
appetite often continues good, and nutrition is frequently not much, if any, 
impaired. Individuals affected are unable long to sustain physical exer- 
tion without exhaustion, and suffer other marked inconveniences ; still, the 



226 DISEASES OF THE RESPIRATORY SYSTEM. 

disease Joes not tend directly to destroy life. Its existence in a patient 
prostrated with any other disease involves danger, from the accumulation 
of the abnormal secretion in the bronchial tubes. Often the disease pro- 
gresses for years, with frequent remissions, many of the urgent symptoms 
subsiding during the summer, to return again with the unfavorable season. 

The first important step in the treatment of chronic bronchitis is the 
removal of the cause, if possible. When it results from irritant inhala- 
tions, such exposure should be obviated. If it co-exists as a complication, 
and is dependent upon some other disease, the affection which excites it 
should first be treated. To improve the general health and restore the 
vital powers are objects of infinite importance. Success of treatment will 
depend much upon correct hygienic surroundings. In this respect, the 
advice given for the guidance of consumptives is applicable to a large pro- 
portion of the cases of chronic bronchitis. Regular modes of living, the 
avoidance of undue exertion, precautions against taking cold, care for 
regular evacuations of the bowels, and the like, are to be mentioned as tend- 
ing to promote the object in view. It is scarcely necessary to insist that 
the diet be most nutritious and generous. The administration of alcoholic 
remedies is frequently demanded in these cases. 

In the selection of medicinal remedies, good judgment and a clear 

understanding of their physiological action are necessary. The general 

impression of patients is that they need medicines to abate the disposition 

to cough; on the contrary, the cough should continue, and even be excited, 

if necessary, as long as the disease exists and there are accumulations in 

the bronchial tubes to be expectorated. Rarely will expectorant remedies, 

such as ipecac, squills, seneka, etc., be needed, but if the expulsion of the 

secretion demands their employment, they should not be withheld. It is 

generally accepted that the use of the iodide of potassium promises good 

results in many cases. One ounce of this agent may be added to a pint of 

water, and of the solution one teaspoonful be taken three times daily. The 

dose should be gradually increased to one tablespoonful. The muriate of 

ammonia has in many instances been found curative, and may be given as 

follows : — 

1^, Amnion, muriatis 3 vj. 

Ext. glycyrrhiz. pulv 3 vj. 

Aquse 3 iv. 

Ft. mist. Sig. : Shake well. Dose, one teaspoonful in water, four times daily. 

The spirit of turpentine is a remedy of acknowledged efficacy in chronic 
bronchitis, and one drop on sugar may be tnken every one or two hours. 
The balsam of copaiba is also advised in a certain class of patients. It is 
impossible to anticipate what agents will be most useful in individual cases; 
some will be active in one, and inert in others. A fair trial should be given 
each, and its administration be discontinued if it is found unsuited. 
Several weeks, at least, will be necessary in all instances to determine the 
relative merits. 



CHAPTER V. 
ASTHMA. 

The term asthma, used in a properly restricted sense, is applied to a 
spasmodic affection of the bronchial tubes. It is characterized by sudden 
attacks of difficult breathing, coming on after longer or shorter intervals, 
increasing rapidly in severity, and lasting either for a few hours or persist- 
ing for several days. In the development of asthma, bronchitis plays an 
important part ; it acts, however, merely as an exciting cause, and in each 
instance there must exist in the nervous system some special predisposing 
condition, without which the paroxysm would not occur. 

Symptoms. A paroxysm of asthma may commence without warning, 
or it may be preceded by precursory symptoms. The majority of patients 
are able to predict an attack some hours before its occurrence, by peculiar 
and possibly ill-defined symptoms, which they alone recognize. There may 
be drowsiness, heaviness, and depression, or an unusual mental excitation 
and buoyancy of spirit. Among other premonitory symptoms, are an 
increased flow of urine, wakefulness, itching of the skin, etc. Paroxysms 
generally occur during the sleeping hours, after midnight or very early in 
the morning. Ordinarily, the individual retires to bed as well as usual, 
and falls asleep ; after an hour or two, his breathing begins to be noisy and 
wheezing, and he is soon awakened by a most distressing sense of 
approaching suffocation. His breathing is very laborious, and his respira- 
tion is attended with an audible whistling and rattling. Rapidly the 
difficulty in breathing increases to an excessive degree, and the patient 
can no longer lie clown, but sits up in bed, rests his elbows on his knees, 
and with fixed head, elevated shoulders, and mouth open, he gasps for air. 
The respirations are not usually increased in frequency, but may be even 
less than in health. The inspirations are spasmodic efforts, short and 
jerking, while the expirations are prolonged, accompanied with a wheezing 
sound, and terminate in a sudden expulsive effort. Speech is difficult and 
interrupted. The patient insists that the windows be opened, even in mid- 
winter, or lie hurries to them for a breath of fresh air. If the struggle to 
breathe is great, he is soon dripping with perspiration, his face is pallid, 
sometimes has a bluish cast, and presents a ghastly appearance. The 

227 



L-b DISEASES OF THE RESPIRATORY SYSTEM. 

nostrils dilate, and the veins of the nock are swollen and seem bursting. 
During the paroxysm the pulse is small and feeble, and if the suffering is 
prolonged, the extremities become cold, blue, and shrunken, and death 
seems approaching. 

Attacks of asthma differ much in severity and duration. It has been 
truly said that a patient suffering from a severe paroxysm presents a 
spectacle more distressing than can be well imagined; to one not familiar 
with the disease, he appears to be on the point of death. Even in what are 
deemed mild attacks, the suffering is considerable. Paroxysms sometimes 
are of but a few minutes' duration ; they may pass off in an hour or two, 
and in rare instances they continue two or three days. When relief comes, 
the patient begins to cough and expectorate, and he usually soon falls into 
a quiet and refreshing sleep. The expectoration is frequently very frothy, 
grayish-white, and sometimes it consists of a few small round mucous 
pellets of a jelly-like consistence. There are often blood-streaks in the 
sputa, and sometimes a true hemorrhage takes j)lace. 

Paroxysms of asthma recur after intervals varying greatly in duration 
in different cases. Some patients experience attacks regularly and at 
stated periods ; in others, the recurrences are extremely irregular. During 
the interval the condition of the asthmatic subject varies; some are 
perfectly well, if the affection is uncomplicated, and not due to any organic 
disease ; others complain of a sense of constriction in the chest and labored 
breathing during active exercise. Asthma is occasionally associated with 
chronic bronchitis, and in such patients paroxysms are excited by slight 
exposure. In rare instances daily recurrences of the affection are suffered ; 
then it is almost always complicated with bronchitis or disease of the 
heart. 

Causation. The primary cause of asthma is some peculiarity of 
constitution, characterized by a susceptibility in the muscular fibres of the 
bronchial tubes to take on spasm. It is essentially a spasmodic affection, 
during the existence of which the tubes are narrowed and contracted, and 
the free passage of air into the air-cells is interrupted. In about forty per 
cent of cases, the predisposition to the disease is transmitted by inherit- 
ance. No period of life is exempt from it ; more frequently it is met with 
between thirty and forty years, and in occasional instances it is deferred 
until old age. 

The exciting causes of asthma are very numerous. Many cases are 
developed by irritating inhalations, such as the powder of ipecac, dust that 
arises when carpeted rooms are swept, the fumes of burning sulphur, many 
chemical vapors, smoke, fog, emanations from newly mown hay, from 
feather-beds or pillows, stables, certain fragrant blossoms, sulphur matches, 
burning sealing-wax, also the emanations from certain animals, cats, 
horses, etc. The atmospheric changes are influential in exciting the 
affection ; pure mountain-air develops it in some and relieves it in others. 



ASTHMA. 229 

Paroxysms of asthma may be induced by a variety of other causes, 
among them cold, errors in diet, constipation, uterine disease, and 
hemorrhoidal tumors. It also occurs as a complication, or co-exists with 
bronchitis, heart disease, and with several other affections of the bronchial 
tubes. In such cases it is aggravated by or most likely to follow fatigue 
and physical exertion. The term hay asthma is applied to attacks occur- 
ring only during the summer season ; the exciting cause may not proceed 
from hay alone, but other agencies induce the affection. 

Diagnosis. Rarely will any difficulty be experienced in diagnosing 
well marked cases of asthma. On auscultation are heard sounds incident 
to the affection. They are dry and frequently musical, produced by 
narrowing of the calibre of the bronchial tubes. If high in pitch, they are 
whistling, and generally produced within small-sized tubes; if low, they 
are sonorous or snoring, and emanate from the larger tubes. The former 
are heard on inspiration, and the latter on expiration. 

.Prognosis. Death never results from a paroxysm of asthma if the 
disease is uncomplicated. If the patient has experienced one attack, it is 
presumptive evidence that he will have another, and the tendency of the 
disease is to become confirmed. The chances of a return of the paroxysms, 
however, depend upon the cause. In youth it is much oftener cured than 
in adults. Asthmatic patients are frequently long-lived ; those who reach 
old age do so by a most careful observance of the law r s of health. The 
danger is that the frequently recurring paroxysms will eventually induce 
dilatation of the air-cells, congestion of the lungs, or heart disease. 

Treatment. It naturally follows that the first essential in treatment 
during a paroxysm is to remove, if possible, the cause which excites it. 
If constipation induces it, then an enema should be at once given ; if it is 
dependent upon an overloaded stomach, an emetic is indicated. When 
irritant inhalations are the cause, and are still active, they should be 
removed. 

Patients who have had previous experience with asthmatic attacks are 
generally familiar with those agents which are in their own cases most 
efficacious in relaxing the spasm in the bronchial tubes. Measures which 
are serviceable in some cases are often valueless in others ; the object should 
be to discover, if possible, the remedy which will prove effectual in each 
individual case. Fumes are much in vogue, and, with some, tobacco is 
quite sufficient to cut short the paroxysms. Many, however, find it 
difficult to use this remedy, and succeed with cigarettes made of stramonium, 
or they smoke the leaves of that plant in a pipe. Others still are in the 
habit of entering small rooms the air of which is impregnated with the 
fumes of burning nitre and stramonium ; one drachm of the former is 
added to one ounce of the leaves and lightly mixed. This powder in 
small quantities is burned on live coals, and the patient inhales the rising 
smoke until relief is experienced. 



DISEASES OF THE RESPIRATORY SYSTEM. 

The inhalation of other is often a successful measure, and frequently 
paroxysms are quickly and completely controlled by it. Some patients find 

the nitrate of amy] effective, four or five drops being inhaled from a hand- 
kerchief. Dr. Monell states that he succeeded in obtaining relief in an 

attack of asthma by prolonging as far as practicable the expiratory act, 
then waiting as long as possible before inspiring, and retaining the air at 
the end of the inspiration as long as possible. It requires great exertion 
on the part of the patient to do this. The first attempt at retaining the 
inspired air during a paroxysm will canse him to think he cannot con- 
tinue it, but perseverance will soon delight him with relief from the 
bj sm. 

Stimulants are often serviceable remedies in asthmatic attacks, and those 
principally used are alcohol and coffee. The latter is the more efficacious, 
and should be taken strong, without milk or sugar, and as hot as can be 
swallowed. If several cups of this stimulant are administered immediately 
on the commencement of a paroxysm, it will not infrequently be warded 
off. Alcoholic stimulants some patients employ with marked success; they 
drink toddy hot and strong, and in doses sufficiently large to produce its 
intoxicating effects. 

With most asthmatics the fuming and stimulant remedies give more or 
less complete relief, but with others, and fortunately a very small class, 
they are useless and inoperative. In such cases, an emetic is the agent 
which promises to be serviceable. Of the remedies used for the purpose, 
ipecac is the most reliable, and should be given in one dose of twenty 
grains. The occasional use of emetics can do the patient no harm, but 
their frequent and continued employment would invite derangement and 
debility. When the danger of such a result exists, it would be wise to 
lessen the dose of ipecac, if need be, and merely produce nausea, without 
vomiting. 

The treatment to be instituted between the paroxysms is of special 
importance, the object being to prevent their recurrence. To this end, all 
those sources of injury which the patient knows have produced previous 
attacks, or favored their occurrence, should be avoided or removed, if 
possible. If the patient has the so-called hay asthma, he should seek a 
situation where he is no longer exposed to the exciting cause. Asthmatics 
who find that their sufferings are greater in certain localities should 
endeavor to secure relief by a change of residence. Often those residing 
in the country are free from attacks while living in cities and large towns, 
and not infrequently a removal from one part of a city to another will 
secure exemption. The writer recalls cases where patients living on the 
ground-floor changed to upper apartments in the same house, and found 
great relief. As Flint says: "There are no fixed laws with respect to the 
best climate or situation for asthmatics ; each case has its own law, which 
is only to be ascertained by experience. In commencing trials of change 



ASTHMA. 231 

of residence, a place should be selected in which the climatic influences are 
the opposite of those belonging to that in which the patient resides ; that 
is, if the residence be in the country, the city may be tried, and vice versa; 
if on the seashore, an inland situation, and vice versa; and so with 
regard to temperature, moisture, elevation, etc. The principle to be 
acted 'on is that there is a place in which each martyr to this complaint 
will suffer less, and perhaps be entirely free from it, and the plan should 
be to make repeated trials until the desired spot is found." 

Asthmatic patients should seek to overcome all co-existing bodily 
infirmities, and perfect their general health. Iron, quinine, cod-liver oil, 
and other tonics should be taken, if needed. In a large proportion of cases, 
the existence of bronchitis increases the liability to paroxysms, and the 
relief or cure of that affection is indicated. In very many cases of asthma, 
marked improvement results from the use for several weeks of the follow- 
ing mixture : — 

J£ Potass, iodidi 3 ij- 

Spt. amnion, arom S ij* 

Tr. belladonna 5 ss. 

Tr. cinch, comp 5 i v « 

Aq. menth. pip 5 ij* 

Ft. mist. Sig. : Dose, one teaspoonful, three times daily, before meals. 

In very obstinate cases, in which all other remedies advised have 
failed, the following should be given until it is evident that this treatment 
is also ineffectual : — 

J^, Quinise muriatis 3 j. 

Acid, arseniosi gr. j. 

Atropi£e gr. ss. 

Ext. gentian 3 j. 

Ft. pil. No. 60. Sig. : Dose, one pill, daily; then, after a few days, one twice daily; 
gradually increase the quantity, until one is taken morning, noon, and night, and at 
bedtime. 



CHAPTER VI. 
ACUTE CORYZA. 

Acute corvza is an acute inflammation of the nasal mucous membrane. 
The affection is commonly known as "a cold in the head"; and the term 
nasal catarrh has also been applied, both by the profession and the laity. 
The symptoms which usher in corvza are a feeling of lassitude, slight 
chilliness, and a sensation of weight and pressure in the head, especially 
about the forehead. At the same time there is a prickling and dryness of 
the nose, and sneezing is easily provoked. Redness and swelling of the 
mucous membrane involved soon supervene, and the uncomfortable sensa- 
tion caused by the arrested secretion is somewhat relieved by a free dis- 
charge. The flow is at first watery, then of a mucous quality ; finally it 
becomes more or less purulent in character. There is usually a partial loss 
of the sense of smell ; sometimes that of taste is also affected. Fever 
occasionally exists, but it is rarely of marked intensity. 

Coryza may be communicated from one person to another, both by 
direct contact with the secretion, as in using the same handkerchief, etc., 
and also by mere approximation of the diseased organ to a healthy one, as in 
the act of kissing. It is now generally assumed that the affection owes its 
origin to a special cause; that it is probably parasitic, and propagated by a 
specific micro-organism. This point has never been established with cer- 
tainty, and before the germ theory can be accepted, no matter on what 
rational grounds it is based, it will be necessary for comj^etent micro- 
scopists to institute a thoroughly scientific investigation, to prove that a 
specific germ is always present in this affection, and never found in any 
other condition. 

If it can be demonstrated, as some attempt to prove, that cold has very 
little to do with the direct causation of coryza, it certainly should be num- 
bered among the predisposing causes. A cold in the head is frequently 
attributed to wet feet, and it is not to be denied that that part of the body 
is most exposed to atmospheric vicissitudes. Coryza may be induced by 
irritants affecting the nose directly, such as tobacco, dust, acrid fumes from 
chemicals, or by direct injury, wounds, or the entrance of foreign bodies 
into the nasal passages. Coryza is often the first stage of various acute 
infectious diseases, especially measles, typhus, and influenza. 

232 



CHRONIC NASAL CATARRH. 233 

The disease under consideration, when uncomplicated, lends to rapid 
recovery, and runs its course in from two to seven days. It rarely ends in 
the chronic form of the disease, unless it is neglected, or the patient 
affected suffers from some marked constitutional disturbance. In occa- 
sional cases the inflammation extends into the passages leading to the ears, 
giving rise to a crackling sensation on swallowing, and ringing noises, and 
impairing somewhat the power of hearing. The tear-duct, leading from the 
eyes to the nose, is also often inflamed, and for a time closed. 

Coryza, if treated immediately on the first appearance of symptoms, 
may in some instances be aborted. The remedy which promises the best 
results is quinine, and a dose of ten grains should be administered. If this 
does not arrest the disease, it will usually modify its severity. 

Inhalations often relieve the discomfort experienced during an attack 
of coryza, by exciting an increased flow of secretion. Ammonia, carbolic 
acid, and alcohol can be used to saturate a sponge confined in a bottle, 
which should be kept tightly closed when not in use ; the proportionate 
quantity is five drachms of each of the first two, to two ounces of the 
last. Iodine and cologne are also employed for the same purpose, and in 
the same manner. The ordinary fluid preparation of witch-hazel is an 
agreeable application, and may be diluted with one or two parts of water, 
and snuffed up the nose. If there is considerable pain, or a tendency to 
excessive sneezing, a powder of morphine and the subnitrate of bismuth 
will be found efficacious, one grain of the former to two drachms of the 
latter. Of this a small "pinch" can be snuffed up occasionally. 

CHRONIC NASAL, CATARRH. 

Chronic nasal catarrh is a chronic inflammation of the nasal mucous 
membrane, characterized, in some cases, by an excessive and persistent dis- 
charge of mucus ; in others, by a retention and decomposition of the nasal 
secretion. It is necessary to distinguish two forms of this disease. In one 
variety, the mucous membrane appears thickened and livid ; in the other, 
on the contrary, the membrane has become atrophied, and is thin and pale. 
Both varieties often co-exist, but the latter is most commonly found in old 
cases, and seems to be the result of the former. 

The affection under consideration is sometimes caused by the lodgement 
of foreign bodies in the nostrils ; it is commonly associated with diseases 
of the bony structures, ulcerations and abnormal growths within the nose. 
Many individuals suffer from a peculiar constitutional tendency to this 
affection. An abnormally moist or impure air may develop it. Doubtless, 
among the most potent causes in the large towns and cities are sewer-gas 
and emanations from defective drains. It is also favored by certain 
occupations, such as wood-turning, soldering, milling, cigar-making, etc., in 
which the atmosphere is dry and dusty. Irregularities in living, insuf- 



DISEASES OF THK RESPIRATORY SYSTEM. 

ficient clothing, frequent and continued exposure to wet and cold, also 
predispose to it. 

The secretion in this disease varies much, both in amount and character. 

There are forms in which it is very abundant, while in others it is scanty, 
and to such the name dry catarrh is applied. In some cases there are 
constant watery mucous discharges; in others, thick, tenacious mucus 
collects in the nostrils, and small masses drop into the throat, producing 
irritation, coughing, and retching. The secretion may carry with it 
sufficient fluid to flow easily away, or it may be thick, with a tendency to 
form crusts. These accumulate and obstruct nasal respiration, causing 
much discomfort. Occasionally, the retained secretion decomposes, and 
an annoying fetor is generated. In general, it may be asserted that the 
longer nasal catarrh exists, the more it inclines to the "dry form"; 
and the greater will be the tendency of the secretion to thicken into 
crusts. 

The crusts present a greenish appearance, and if they contain blood, or 
dust adheres to them, they are parti-colored. In size they vary much, 
being small in some instances ; in others, they cover a large surface, 
like a false membrane ; occasionally, when thrown out, they retain the 
form of the passage in which they accumulated. The odor of the secre- 
tion in nasal catarrh, while of various degrees of intensity, still is peculiar 
to the affection. In some cases it is musty; in others, the fetor is much 
more pronounced, and has been compared to crushed beddjugs. When 
this complication appears, chronic catarrh is called ozdkna. Patients 
suffering from ozsena are seldom disturbed by the odor, as the sense of 
smell is usually destroyed or seriously interfered with ; to their associates 
they are painfully offensive. 

Chronic nasal catarrh presents a variety of symptoms aside from those 
already described. A continuous discharge of watery mucus escaping 
from the nostrils, often causes an abrasion of the skin beneath. Occasion- 
ally neuralgia is produced by pressure of the thickening tissues upon the 
nerves distributed to them. The nasal passages may be temporarily or 
permanently closed. Pain in the forehead not infrequently co-exists. 
The tendency of this disease is to extend posteriorly into the pharynx. 
In such cases, hearing is sometimes impaired, either by the extension of 
the catarrhal process, or collapse of the Eustachian tube. 

Chronic catarrh almost always admits of a favorable prognosis as 
regards life. On the other hand, it is an obstinate evil, often resisting: all 
attempts at treatment, and yet it sometimes heals spontaneously. When 
the general health is impaired, the affection will prove more refractory. 
If catarrhal deafness becomes marked, entire recovery of the hearing 
power cannot be expected. As a rule, the longer nasal catarrh exists, the 
more unfavorable is the prognosis. More or less relief, however, can be 
afforded in all cases. 



CHRONIC NASAL CATARRH. 235 

The first object in treatment is to discover, if possible, the cause, and 
obviate it. If irritants excite the affection, they should be avoided. 
A patient having a constitutional tendency to catarrh should, by a rigid 
observance of the laws of health, develop greater resistant powers. 
Those who easily "take cold" will, by indulging in cold sponge-baths 
daily, become less susceptible to sudden atmospheric changes and vicissi- 
tudes. While local treatment promises much in nasal catarrh, it will the 
more often prove unsuccessful if general infirmities be neglected. Each 
case should be carefully studied, and all derangements overcome, if possible. 
It is important to remember that in as much as the general health is per- 
fected, the local disease will prove less obstinate. 

Pure air and healthy surroundings are of the utmost importance in the 
treatment of this disease. As long as a patient is exposed to sewer-gas 
and foul emanations, a cure will inevitably be resisted. A radical change 
in climate is desirable, when possible ; nearly all affected with catarrh find 
that improvement speedily commences on reaching the mountains. Patients 
living in large towns and cities should at least remove to the suburbs, if a 
more complete change is denied them. Especial care should be observed 
in the selection of a sleeping-room. None adjacent to a bath-room is 
allowable, and on no account should there be in it a stationary basin. A 
room at the top of the house is generally to be preferred, and it is obvi- 
ously desirable that it be thoroughly ventilated at all seasons of the year. 
For patients suffering from catarrh a careful study of the first part of this 
work, devoted to hygiene, is advised. They can be assured that the 
chances of recovery depend more upon correct habits and manner of living, 
and healthy surroundings, than upon the use of drugs. 

In internal medication, efforts must be directed to the improvement of 
the general health. All functional irregularities should be corrected, and 
constitutional weaknesses overcome. Tonics, such as iron, quinine, cod- 
liver oil, etc., are indicated in debilitated states. Chronic catarrh is by no 
means infrequently associated with plethora, and in such conditions a re- 
stricted diet, sufficient exercise, and, possibly, a judicious use of laxatives, 
will be demanded. Some physicians have found the use of cubebs to prove 
very satisfactory in nasal catarrh. This agent may be given as follows : — 

fy Cubebae % U- 

Syr. aurantii § iij. 

Aq. menth. pip % viij. 

Ft. raist. Sig. : Dose, one-half a teaspoonful, every three hours. 

It is necessary to continue the cubebs for one or two months, and by 
their use the sensation of stuffiness in the head, the irritation and constant 
hawking, may be relieved. If diarrhoea or an herpetic eruption appears 
during the treatment, the administration of cubebs should be interrupted 
for a few days. Some patients have found relief by smoking cubebs. 



236 DISEASES OF THE RESPIRATORY SYSTEM. 

They mix thoroughly one ounce of this drug with half an ounce of the 
dried heads of chamomile, and, using a common tobacco-pipe, puff the 
smoke through the nose. 

In the local treatment of catarrh, the object is to loosen the secretions, 
hasten their removal, prevent their retention, and to restore the affected 
mucous membrane to its normal condition. The nasal douche can be most 
conveniently employed. Among the many local remedies, borax, chlorate 
of potassa, and common salt are the most efficient. Any one of these can 
be used in solution, in proportion of a teaspoonful to a quart of water. No 
more concentrated solution than this is allowable, at least at first, as in 
some cases the membrane is easily irritated. It has been urged against the 
nasal douche that inflammations of the ear are caused by it, the liquid 
penetrating, notwithstanding all precautions to the contrary, through the 
Eustachian tube into the cavity of the middle ear. This occurrence is by 
no means as dangerous as has been represented, and patients very easily 
avoid it if they abstain from swallowing while the cleansing operation is 
being performed, and breathe calmly with widely open mouth. The fluid 
should finally be allowed to discharge itself from the nose, without the 
expulsive effort which is quite naturally made by closing one nostril and 
forcing the air through the other passage. 

There are other precautions to be observed in using the nasal douche. 
The jar containing the solution should not be placed too high, or the force 
of the stream will be too great. The fluid should always be warmed to 
about the temperature of the body, and, for a time after douching, the 
patient should remain in a comfortably heated room, for to at once 
encounter cold air would, in many cases, induce an acute catarrhal attack. 

Instead of the douche, the patient may cleanse the nasal cavities by 
drawing up or snuffing up a fluid from a bent tube ; this method is, how- 
ever, much less successful. The prolonged use of the fluid preparation of 
witch-hazel, diluted with one or two parts of w T ater, has proved efficacious 
in many cases. In ozrena, disinfectant solutions are necessary. The per- 
manganate of potash is the most often used, fifteen to twenty grains being 
dissolved in a pint of water, and employed in a douche. This agent is 
simply useful as a disinfectant, and only reaches the surface of the offen- 
sive crusts. In addition, therefore, the cleansing solutions should be 
employed. When the odor is excessively annoying, and frequent douching 
is inconvenient, it will be well to use a snuff made of wood-charcoal and 
myrrh, equal parts. A pinch of this can be taken every hour during the 
intervals between the employment of the cleansing fluids. In ordinarily 
severe cases of nasal catarrh, the douching twice a day will be sufficient. 
In ozaena it will be necessary to use it much oftener. 

In England the chloride of ammonium vapor is much esteemed in the 
treatment of catarrh. It is generated in an inhaler of very simple con- 
struction. A large tube penetrates the cork of a bottle partially filled with 



CHRONIC NASAL CATARRH. 237 

water, and extends nearly to the bottom of the same. Within this tube is 
a short test-tube, the end being perforated with small holes. In this are 
deposited several small pieces of the carbonate of ammonia, and above 
them is suspended an absorbent plug wet in strong hydrochloric acid. 
Another glass tube, small and short, passes through the cork, and with it is 
connected a rubber tube. When sucking through this, the fumes of the 
acid pass over the ammonia, down and out the largest tube, and, rising 
through the water, form in the upper part of the bottle, to be drawn 
into the mouth and expelled through the nostrils, the action being 
precisely similar to that of smoking a cigarette. The continued use of 
this inhaler promises very excellent results. 

Within the past few years, nasal suppositories, containing, among other 
ingredients, iodoform, have been advantageously employed. Applications 
in this form will doubtless yet be even more popular. If, during chronic 
nasal catarrh, the hearing power becomes affected, a skilled specialist 
in diseases of the ear should be early sought, and the entire treatment 
of the case be left to his judgment. 



SECTION II. 
DISEASES OF THE CIRCULATOEY SYSTEM. 



CHAPTER I. 
INTRODUCTORY. 



The circulatory apparatus consists of the heart, arteries, capillaries, and 
veins. The heart is a hollow muscular organ, which receives the blood at 
one orifice, and drives it out in successive impulses at another. The arte- 
ries are a series of branching tubes which convey the blood from the heart 
to the different tissues and organs of the body. The capillaries are a net- 
work of minute connecting tubules, which are interwoven with the sub- 
stance of the tissues, and which bring the blood into intimate contact with 
the cells and fibres of which they are composed. The veins are a set of 
converging vessels, destined to collect the blood from the capillaries and 
return it to the heart. 

Diseases affecting the circulatory system are seated either in the blood- 
vessels or in the central organ of circulation, the heart. Many of them are 
manifested by such vague and ill defined symptoms it is utterly impossible 
to instruct laymen to a certain knowledge of the essential features, unless 
they are first practically familiar with the anatomical construction and 
physiological workings of the parts involved. The heart, for instance, is 
a hollow organ, consisting of four chambers ; the openings into each are 
provided with valves, which regulate the flow of blood as it enters, and as 
it is driven to the lungs and over the body. Certain sounds are caused by 
the opening and shutting of these valves ; in case they become changed 
by disease, and act imperfectly, the fact can only be determined by auscul- 
tation. The modifications are often so slight and so indistinct, they are 
appreciable only to an ear trained by long practice, and one perfectly 
familiar with the normal sounds in health. It is evident that an exhaustive 
treatise on diseases of the heart would be valueless, and therefore only 
those will be fully discussed which it is possible for the laity to recognize. 
Other affections of the circulatory system will be briefly described, it 
being the purpose merely to instruct the reader as to their nature and 
situation. 

238 



PERICARDITIS AND ENDOCARDITIS. 239 



PERICARDITIS. 

The sack in which the heart is enclosed is called the pericardium. 
When this becomes inflamed, the disease is known as pericarditis, and the 
anatomical changes are identically the same as occur in pleuritis. The 
initial stage is one of congestion, attended by two prominent symptoms, 
viz., pain in the region of the heart, and palpitation. Associated with these 
are the usual febrile signs which mark the existence of acute inflammation. 
An effusion of liquid takes place into the sack, usually within one or two 
days; the local pain then diminishes, and symptoms are added which pro- 
ceed from pressure of the fluid upon the heart. These are a sense of 
oppression in the region of that organ, a feeble pulse, a tendency to faint 
on exertion, and difficulty in breathing. 

The severity of the symptoms in pericarditis corresponds to the inten- 
sity of the inflammation and the amount of effusion. If the inflammation 
be slight or moderate, and the quantity of effused liquid small, the disease 
may run its course without any symptoms denoting gravity, or any even 
which point to the chest as the seat of the affection. If recovery takes 
place, the fluid is usually rapidly absorbed. Generally the duration of the 
disease in fatal cases is from one to two weeks. The majority of patients 
attacked with uncomplicated pericarditis recover. The exceptions to this 
rule are met almost exclusively in connection with Bright' s disease of the 
kidneys, and blood-poisoning, or absorption of purulent matter into the 
circulation. 

ENDOCARDITIS. 

Inflammation of the membrane which lines the cavities of the heart, or 
endocardium, is called endocarditis. The affection is usually limited to 
the valves and their attachments. Some forms are rarely completely 
recovered from, but eventuate in a permanent valvular disease. The 
inflammation is usually followed by degenerative changes, either in the 
valves themselves or in the orifices to which they are attached. As 
a consequence, after a period more or less prolonged, obstruction to the 
flow of blood, or its regurgitation through imperfectly shutting valves, 
results. Endocarditis is closely connected with those diseases which are 
characterized by marked changes in the blood. It is more frequently 
associated with acute articular rheumatism. Occasionally the affection 
complicates continued and eruptive fevers, diphtheria, disease of the kid- 
neys, and syphilis. Some forms appear in chronic affections, in alcohol- 
drinkers, and in the aged. 

Endocarditis can only be determined by auscultation, as it presents no 
general symptoms which characterize its existence. In acute affections, 
during the course of which the disease in question is liable to appear, the 
attending physician should frequently examine the heart, or the complica- 



240 DISEASES OF THE CIRCULATORY SYSTEM. 

tion will the more often be overlooked. Life is comparatively rarely 
threatened by endocarditis, but, as regards complete recovery, the progno- 
>is is totally unfavorable, since it is almost certain to result in chronic dis- 
ease of the valves ot" the heart. 



VALVULAR DISEASE OF THE HEART. 

Valvular disease of the heart is more often the continuation of degen- 
erative changes which began as acute endocarditis. Frequently the devel- 
opment is so slow and insidious the actual beginning is concealed, and it 
is almost or quite impossible to determine the influences which were at 
first active. The essential change is the formation in the substance of the 
valves of new fibrous tissue, of firm consistence and a marked tendency 
to retract. The production of this tissue is confined in some cases more 
to the borders of the valves; in other cases more to their hinge-like attach- 
ment, and in some it spreads over the whole valve. As retraction goes on 
and shrinking takes place, the valve becomes stiff and its motion is im- 
peded. Its edges become roughened and irregular by outgrowths, which 
may ulcerate or form into hardened bulbs. The abnormal changes are not 
confined to the valves alone, but their attachments and the edges of the 
orifices which they command are also affected. Thus, after a time, the 
blood, as it flows through the heart, is not only obstructed, but is allowed 
to recede through but imperfectly closing valves. The effect, in its rela- 
tion to circulation, would be purely mechanical, if the force of toe heart 
remained exactly what it was before the degenerative changes commenced. 
It does not, however, remain the same, but those sections of the heart 
which lie before the obstruction to the outflow, or those which are sub- 
jected to the pressure of an overflow, are not only dilated but hypertro- 
phied. The additional resistance is met by additional power, represented 
by the propelling force of the heart. That organ, or departments of it, 
is forced to labor harder to compensate for the disturbance in the circu- 
lation. This compensatory effort is rarely successful in maintaining per- 
fect circulation ; under ordinary conditions, its defects may be unnoticed, 
but respiration is always impeded the moment the smallest extra demands, 
such as active exercise, walking up a hill, etc., are made on its exertions. 
Thus, a person may suffer with heart-disease and be allowed to attend to 
his business for years, provided the same is not one necessitating unusual 
muscular effort. 

When the valves of the heart become diseased, and circulation is 
thereby disturbed, stagnation of the blood is the consequence. It flows 
more slowly through the small vessels, loses far more of its oxygen, and 
takes up a more abundant supply of carbonic acid. Again, less than usual 
of the former is taken up as it passes through the lungs, and less of the 
latter is given off. Both of these defective processes tend to destroy the 



FUNCTIONAL DISORDER OF THE HEART. 241 

bright scarlet color of the blood, and produce a darker, blue-red tin<*e. 

This change is never completely absent, even in the mildest cases of dis- 
turbed circulation; often plainly visible to the eye is the treacherous 
blue flush, in what, to all appearance, is the fresh red hue of the lips. 
This bscomes more evident on extra physical exertion. As the stagnation 
advances, the small veins of the skin, especially of the face, stand out 
more prominently, and those of the leg grow larger and more distorted. 
The different organs of the body, after a time, feel the influence of dis- 
turbed circulation, and share in the abnormal changes. There is manifested 
a train of symptoms peculiar to the affections which are added as compli- 
cations. Sooner or later, if life is not cut off by some intercurrent disease, 
dropsy appears : usually, the lower limbs are first attacked ; afterwards, the 
face and body. 

When once the valves of the heart undergo structural changes, their 
integrity is permanently lost. Hypertrophy precedes dilatation ; and while 
the organ is simply enlarged, serious results, directly attributable to the 
cardiac disease, rarely occur. It is not uncommon for patients affected 
with valvular disease to live many years, and even to old age. After 
dilatation commences, the prognosis is more unfavorable, the fatal result 
being only a question of time. Still, life may be prolonged by judicious 
treatment, and those unfortunates who suffer from heart disease should feel 
a measure of hope that, by a careful avoidance of all excesses, a rigid 
observance of Nature's laws, and a wise use of medicinal agents, the com- 
ing of the evil day may be delayed. 



FUNCTIONAL DISORDER OP THE HEART. 

By the term functional disorder is meant disturbed action of the heart, 
an increased activity not dependent either on inflammation or structural 
changes. This affection is generally known as palpitation. It is a very 
common symptom of organic disease of the heart, and may occur inde- 
pendently, as purely a nervous affection. The direct cause of this func- 
tional disorder is an over-stimulation of the cardiac muscle, or an excita- 
bility from derangement of the nerves which control it. 

Among the various causes of nervous palpitation, mental excitements, 
such as joy, grief, fear, anger, and the like, have a very sudden influence 
on the functional activity of the heart ; homesickness belongs to the same 
group. Diseases of the nervous system — also a temporary irritability of 
the same, the result of excesses — induce the disorder. Among other con- 
ditions which invite an attack are the various diseases of the abdominal 
organs, such as gaseous distention of the intestines, worms, gall-stones, 
renal calculi, and many other abnormalities. It occurs in jflethoric peo- 
ple addicted to indulgences at the table, and who take but little active 
exercise. On the other hand, it is frequently associated with poverty 



242 DISEASES OF THE CIRCULATORY SYSTEM. 

of the blood. Jn some individuals it appears to be dependent upon 
indigestion, the immoderate use of tobaceo, alcohol, coffee, and tea. 
In fact, all influences interfering with the restraining power of the 
nerves which control the heart's action are influential in causing palpi- 
tation. 

The symptoms are manifested with variable intensity. As has been 
stated, " whenever a person becomes sensible of the beating of his own 
heart, he may be said to have cardiac palpitation ; by the term is under- 
stood an unnaturally strong cardiac impulse, accompanied by an unnat- 
urally rapid action of the heart, which may be irregular or intermitting." 
As that organ hammers, as it were, on the chest-wall, patients complain 
of a choking, "fluttering" sensation. There is a sense of oppression, and 
even death seems imminent ; dizziness and a feeling of faintness, flashes of 
light, or spots floating before the eyes, are not infrequently associated 
with palpitation. In some cases, the face is flushed and heated; in 
others, it is pallid, and bathed in cold sweat. Many patients cannot lie 
down, and only find relief in an upright position ; difficulty in breathing- 
is often marked. The pulse may vary greatly in its frequency ; in some 
cases it is extremely rapid, and will not admit of being counted. It may 
be strong and regular, but often it is small, scarcely perceptible, and very 
irregular. 

Attacks of palpitation are of variable duration, lasting several minutes, 
or hours, or even a whole day. Although they are a source of great 
uneasiness, and though the patients suffer from a constant apprehension of 
their recurrence, yet, when the affection occurs independently of organic 
disease of the heart, the prognosis is always good, as the derangement 
never destroys life. The possibility of a cure depends upon the cause ; and 
if that can be removed, the heart will renew its normal action. In all cases 
of palpitation a physician should be consulted, as it is extremely desirable 
for the welfare and comfort of the patient to know positively that no 
structural disease exists. 

The treatment demands the removal of the underlying cause, if possible ; 
and, to this end, the enrployment of appropriate remedies is indicated. If 
the affection occurs in connection with plethora, the diet should be 
restricted, laxatives used, and exercise be insisted upon. If poverty of the 
blood exists, then large doses of iron must be taken, for a long period. In 
all cases it is important to be familiar with the laws of hygiene, and to 
regulate daily life and habits in consonance with them. A cure is often 
resisted by mental inquietude, occasioned by the fear of sudden death ; 
positive assurance that no danger exists does much to hasten recovery. If 
attacks are of frequent occurrence, a belladonna plaster, in size six by 
seven inches, should be constantly w T orn over the heart. In nearly all cases 
the following mixture will be found efficacious : — 



ANGINA PECTORIS. 24 3 

JjJ, Amnion, bromkl 3 j. 

Potass, broinid 3 iv, 

Aq. mentb. pip 3 i y « 

Ft. mist. Sig. : Dose, one teaspoonful, in water. 

If the attack is severe, one dose should be given every half-hour until 
relief is experienced. If the interval between the paroxysms is short, it 
will be well to administer the medicine regularly, for a brief period, 
three or four times a day. 



ANGINA PECTORIS. 

Angina pectoris, commonly known as neuralgia of the heart, is 
an affection involving the cardiac nervous system. The prominent symp- 
tom which characterizes this affection is an intensely agonizing pain 
in the region of the heart, occurring suddenly and in paroxysms, usually 
extending over the left side of the chest, through the back, and along 
the left arm. More rarely it radiates over both sides and arms. The 
pain is of a lancinating, stabbing character, and with it is associated a 
peculiar sensation of anxiety and impending suffocation; a patient feels 
as though in the grasp of death. At the commencement of an attack, 
the face becomes bloodless, and expressive of the most intense suffering ; 
the body is soon bathed in cold perspiration, the heart beats irregularly, 
sometimes violently ; at times, its pulsations are feeble, and may be almost 
imperceptible ; in occasional instances, its action is undisturbed. When 
the paroxysm comes on, the sufferer, if walking or at work, seizes hold 
of some firm support, and is instantly fixed and motionless. His res- 
piration is affected, as he fears to breathe freely and deeply ; and, in excep- 
tional cases, there is a general sensation of chilliness, with chattering of 
the teeth. 

The symptoms described are characteristic of a severe attack of angina 
pectoris ; milder forms are not infrequent. The paroxysms vary in dura- 
tion and frequency of their recurrence. Usually they subside after a few 
moments, rarely persisting for an hour. As a rule, when one attack of 
the affection has been experienced, others are quite sure to follow, sooner 
or later, and generally they become progressively more frequent. At first, 
and for some time, the paroxysms are excited by an evident cause, such 
as great muscular exertion or intense mental excitement, but after a 
time they occur from trivial influences, or apparently come on sponta- 
neously. 

Of the causative conditions essential to the development of angina 
pectoris, little is known. Since the affection occurs in the different forms 
of heart disease, upon those abnormal changes it is reasonable to assume 
its existence depends. When uncomplicated and unassociated with any 



-44 DISEASES OF THE CIRCULATORY SYSTEM. 

evident organic disease^ certain predisposing causes must be regarded as 
influential in exciting it. Among them may be numbered poverty of the 
blood, exposure to cold, and excessive use of tobacco. Other morbid 
conditions, similar in character to those upon which neuralgia commonly 
depends, doubtless are as potent factors in the causation of angina pec- 
toris. 

It is practically important to determine in all cases whether the dis- 
ease is purely nervous, or whether it complicates an organic disease of the 
heart. In the former class of cases the prognosis as concerning life is 
favorable, for death is rarely caused by the attacks, however severe they 
may seem. A radical cure is quite possible in such cases, if the evil and 
exciting influences can be determined. When angina pectoris co-exi'sts 
with heart disease, the danger of sudden death is infinitely greater. As 
one author says: "Sometimes the first attack proves fatal; in more 
instances, the second or third ; while in many more, perhaps in the majority 
of instances, the patient at irregular intervals experiences a succession 
of attacks, each paroxysm being more severe than the previous one, 
until, finally, after a period extending from one to six or eight years, 
an attack occurs in which the heart's action is arrested and death 
ensues." 

During a paroxysm of angina pectoris, palliative measures should be 
applied, promptly, and sufficiently to relieve the pain. If a physician be at 
hand, he will wisely administer morphine hypodermically. The nitrite of 
amyl is a valuable remedy, and persons subject to attacks of the disease 
should be provided with this drug. In many cases it is effectual, and 
often arrests a paroxysm almost instantly. When resorted to, five drops 
should be inhaled from a handkerchief held over the nostrils. If the 
heart's action is feeble, alcoholic stimulants are indicated. External 
applications assist somewhat in relieving the pain, and a strong mustard 
paste over the heart is advised. In occasional cases, the nitrite of amyl 
will not entirely dispel the pain, but merely dull it ; in such it would 
be well to use the following : — 

JjJ, Sodii nitritis 3 j. 

Aquae 5 n 2- 

Ft. mist. Sig. : Dose, one to two teaspoonfuls. One dose should be taken 
as soon as the pain is felt. 

The quantity of the mixture necessary to cut short an attack will 
depend upon the purity of the principal ingredient. Rarely is it possible 
to secure the nitrite of sodium without inert adulteration. Were it other- 
wise, one-half a teaspoonful of the preparation would be quite sufficient, 
but, considering its almost constant impurity, it will doubtless be necessary 
to use one teaspoonful, and possibly two. This dose should not be repeated 
for several hours, unless sanctioned by a physician. 



GENERAL TREATMENT OF ANGINA PECTORIS. 245 

The general treatment demands that, during the intervals between the 
paroxysms, patients should carefully avoid all exciting influences, such as 
violent emotions, active physical exercise, over-eating, the abuse of alcohol, 
etc. The object should be to improve the general health, and, if organic 
disease of the heart co-exists, appropriate measures are indicated. 



CHAPTER II. 

SIMPLE ANEMIA. 

Simple anaemia is a condition in which the integrity of the blood is 
impaired by a diminution of certain of its constituents. It is a disease of 
the blood-forming, not of the circulatory system, but, with others similar 
in character, which follow in this chapter, it is more conveniently con- 
sidered with affections of the latter. Anaemia is presented in a variety of 
forms, and the profession use terms distinctive of each. In this work a 
nicety of discrimination would be of no practical value whatever. The 
tissues of the body draw the supplies needed for their growth and func- 
tional activity from the blood ; the well-being of the entire organization, in 
fact, depends upon an adequate supply of that circulatory fluid. When it 
becomes deficient in its nutrient and essential vitalizing elements, disturb- 
ances of function and nutrition, and these morbid changes, combined, con- 
stitute anaemia, or, as it is commonly known, impoverishment of the 
blood. 

Among the obvious causes of this disease are loss of blood, or hemor- 
rhages, deficient supply of food, want of sunlight and pure air, exhausting 
bodily labor ; also insufficient muscular exercise, prolonged and excessive 
heat and cold, depressing emotions, dyspepsia, intestinal worms, pregnancy, 
nursing, fevers, and other abnormal states attended with exhausting dis- 
charges other than blood. To this list may be added certain poisonous 
and infective agencies which interfere with the blood-forming process, 
namely, lead, malaria, etc. 

Anaemia occurs as an acute affection, when resulting from a sudden and 
excessive loss of blood and severe febrile disturbances. The symptoms 
which appear after profuse hemorrhages are extreme pallor, hollow cheeks 
and sunken eyes, skin cold, and, more commonly, bathed in a clammy perspi- 
ration; the pulse is feeble and rapid, and the number of beats usually under- 
goes great and sudden increase when the patient makes any exertion, or 
assumes the erect posture. Fainting is of frequent occurrence ; hiccough, 
vomiting, flashes of light before the eyes, followed by dimness of vision, 
and loss of hearing, are occasional manifestations. In exceptionally sud- 
den cases of hemorrhage severe general convulsions set in before death. 

246 



SIMPLE ANiEMIA. 247 

In chronic anaemia the skin and visible mucous membranes lose their 
color and become pale and bloodless; the former assumes a waxy cast and 
a sallow hue. Nutrition usually suffers in proportion to the duration of 
the anaemia, and emaciation is progressive. The fat disappears, leaving the 
skin thin and wrinkled; the muscles waste, grow soft and flabby; dropsy, 
while not constant, is yet a frequent manifestation. Patients suffering 
from this affection are susceptible to cold, prone to shiver, and especially 
complain of cold extremities. As Flint says : " Anaemia gives rise to a 
multiplicity of morbid phenomena, representing especial disorder of the 
nervous system. The more prominent and frequent are as follows : mental 
depression, anxiety respecting health, irritability of mind, want of buoy- 
ancy and energy, a feeling of lassitude, and a painful sense of inertia or 
indolence. There is apt to be a feeling of incapacity for muscular exer- 
tion greater than the actual loss of muscular power. The physical and 
mental powers are especially depressed during digestion. Palpitation of 
the heart is frequent ; organic disease is greatly feared by the patient. 
Neuralgia, in various situations, is apt to occur, and, in women, hyper- 
aesthesia of the abdominal walls, simulating peritonitis." The appetite is 
capricious : sometimes it is morbid and craving; more often much less food 
is taken than in health, and what is taken is but imperfectly digested. 

The duration of anaemia is extremely variable ; some individuals, espe- 
cially women, surfer for years, even a lifetime, from impoverishment of the 
blood. The prospects of a cure are good when the cause can be deter- 
mined and is eradicable. The longer anaemia exists, the more slowly will 
it succumb to treatment. When it is associated with, or is dependent 
upon, organic disease, the prognosis is a gloomy one. The same may be 
said if the affection is severe and progressive, and the cause cannot be 
determined. In uncomplicated cases, not a little will depend upon the 
patient's circumstances, his age, constitution, mode of living, etc. If he 
is pleasantly surrounded and has good reparative powers, his chances of 
complete recovery are infinitely greater than one unfavorably placed, of a 
sluggish temperament, irregular in habits, and to whom many of the essen- 
tials of life are denied. 

Of the prevention of anaemia it has been pertinently said : " It is one of 
the most important problems of hygiene, both public and private; indeed, 
it is all but co-extensive with the latter. On the one hand, the idiopathic 
forms of anaemia originate, for the most part, in some quantitative or quali- 
tative defects in the requirements of life — in some deficiency or one-sided 
excess of the necessary vital stimuli. On the other hand, the main busi- 
ness of practical hygiene is to harmonize and regulate those outward con- 
ditions, whether for the individual or for the community. Hence it is 
clear that the development of anaemia will be prevented in proportion as 
the purposes of hygiene are carried out successfully." Of the first impor- 
tance in the treatment of this disease is a generous, nutritious, and varied, 



24 S DISEASES OF THE CIRCULATORY SYSTEM. 

diet. The appetite should be stimulated by quinine or other tonic reme- 
dies, and it dyspeptic ailments exist, they will demand appropriate 

measures. A deprivation of pure air and sunlight is productive of 
anaemia, and an adequate allowance of both is essential to recovery. 
Sufficient exercise is also requisite; the same may be said of all hygienic 
measures which promote greater functional activity and renew the vital 
forces. 

Alcohol is an important ingredient in the dietary of anaemic patients. 
A careful estimate of the quantity which can be taken and well borne is 
absolutely necessary. It should be remembered that in small quantities 
this agent assists digestion, while in excess it interferes with the same. 
Probably a teaspoonful of pure brandy, given several times a day, would be 
productive of excellent results. Some patients will prefer a milder form 
of stimulant ; in such cases, Burgundy, Madeira, and other generous but not 
too sweet wines, can be substituted. That many vile adulterations are 
made, agreeable to the taste but pernicious in effect, should not be for- 
gotten. Malt liquors may be recommended for anaemic women and 
children. 

In the medicinal treatment of anaemia, iron is the sovereign remedy. 
There are many preparations, and the patient's condition should be 
considered in the selection. If dyspeptic symptoms exist, often the 
elixir of calisaya bark, iron, and strychnia will be found the most ser- 
viceable. This preparation should be taken after eating ; the commenc- 
ing dose is one teaspoonful, and it can be gradually increased to two tea- 
spoonfuls. All ferruginous tonics ought to enter the stomach with the 
food, and three times each day the dose should be taken. If there is no 
dyspeptic ailment, the tincture of the chloride of iron, in twenty-drop 
doses, well diluted, gives usually the best results. Occasionally iron alone 
fails to improve the patient, and other tonics must be added to the treat- 
ment. The following combination is often efficacious : — 

fy Sol. Fowleri 3 iss. 

Ferri et aramon. citrat 3 ij. 

Tinct. nuc. vomicae 3 ij. 

Tinct. cinclion. co ^ iv. 

Ft. mist. Sig. : Dose, one teaspoonful, three times daily, after meals. 

Pills of metallic iron in a reduced form are easily digested, and often of 
great value. It will be well to change from one preparation to another 
after a few weeks ; this method is usually most effective. If much emacia- 
tion exists, cod-liver oil is indicated, or, if that cannot be taken, then 
malt-extracts may be substituted, as they fulfil much the same purpose. 
Anaemic patients should appreciate the fact that in nearly all cases treat- 
ment must necessarily be prolonged many weeks, and even months. Xone 
of the remedies advised are immediately active, and their use should be 



CHLOROSIS. 249 

patiently persisted in. While iron is being taken, tea should not be 
indulged in, as the astringent principle of the latter is incompatible with 
the former. 

CHLOROSIS. 

Chlorosis is a special form of anaemia, which occurs almost exclusively 
in girls between the ages of fourteen and twenty-four. The disease is pop- 
ularly known as "green-sickness," from the peculiar discoloration of the 
skin which characterizes it. It is essential to discriminate between chlo- 
rosis and anaemia, for not only is the prognosis but also the treatment very 
different in the two conditions. The first symptoms of this disease gener- 
ally appear after the changes peculiar to womanhood are manifested. For 
a time there is usually no irregularity ; then this trouble begins to develop. 
As a general rule, it seems to be originally due to some strong mental or 
emotional disturbance, and homesickness is regarded as one of its most 
frequent causes. The flush of health first begins to fade from her face ; 
the young woman grows pale, and functional irregularities then become 
noticeable. The period, which normally occurred at regular intervals 
and continued five or six days, is shortened to as many hours, and possibly 
is entirely absent. Other symptoms that generally follow are obstinate 
constipation, disordered gastric digestion, irregularity and violence of the 
heart's action ; and marked nervous disturbances, lassitude, muscular weak- 
ness, and cardiac palpitation are very common. 

In chlorotic females the countenance assumes a peculiar waxy, yellow- 
green pallor; the face is generally puffy, and the eyes are surrounded with 
deep, dark circles. The tongue is soft, white, and indented with the teeth ; 
the mucous membranes are very pale and almost bloodless. The pulse is 
rapid and quite small. The appetite in nearly all cases is perverted, and 
the abnormal desires are distinctive of chlorosis. Not uncommonly are 
manifested cravings for the most indigestible substances, and chalk, slate- 
pencils, charcoal, strongly acid and spiced food, even ashes and dirt, are 
eaten with avidity. 

Relative integrity of nutrition outwardly appears to be maintained ; 
there is an absence of emaciation, and even a tendency to embonpoint exists. 
Difficult breathing is often an attendant symptom, and is accompanied by 
a short, dry cough. Patients are melancholy, abstracted, irritable, and not 
infrequently hysterical. In a proportion of cases a pain in the left side is 
complained of; it usually persists, with greater or less intensity, and is 
always aggravated by exercise. 

Chlorosis is a disease of the nervous system. Foremost among the pre- 
disposing causes are sex, age, inheritance, constitution and habit of body, 
local errors of development, and conditions incidental to modern social 
life. Among the exciting causes may be included depressing emotions of 
great intensity, radical changes in the manner of living, late hours, iusuf- 



250 DISEASES OF THE CIRCULATORY SYSTEM. 

ficient sloop, want of exercise, restless nights, premature over-exertion of 
the mind, and habits secretly indulged in. This disease is much more 
common in largo towns and cities, where the social indulgences inflict severe 
penalties upon young growing girls. The popular system of instruction in 
public schools is answerable for many cases of chlorosis; they are propa- 
gated by that most pernicious custom of condensing into a few years the 
courses of study which should be extended over a much longer period. 

If chlorotic patients were allowed a complete change of scene, with 
something new constantly to engage their attention for a number of 
months, they would recover more quickly than if any other course were 
pursued. In cases where it is impossible for them to go on a prolonged 
tour, lesser changes in the manner of life are often of great service. Thus, 
an alteration of the surroundings at home, the removal from school, the 
change from the city to the country, or vice versa, all prove beneficial in 
certain instances. It is important, also, to improve the nutrition in every 
way possible, and hence the patient should have a most generous diet, con- 
sisting of food which will make blood rapidly, such as milk, eggs, animal 
broths, etc. The dietetic treatment is indirectly active upon the disease, 
as it counteracts the poorness of the blood, which is one of the principal 
features. To this end, therefore, chlorotic patients, instead of having three 
meals a day, should have six, although the intermediate ones may be light, 
and consist principally of fresh, unboiled eggs. A careful selection of the 
diet will be necessary, and too much nourishment should not be taken at 
once, lest the stomach be overloaded. 

Exercise is imperatively demanded in nearly all cases of chlorosis. It 
should not be confined to walking alone, but light gymnastics ought also 
to be indulged in. Among the serviceable medicinal remedies are iron, 
the hypophosphites, strychnia, and arsenic. Five drops of Fowler's solu- 
tion often accomplish greater good than iron, and in some cases the two 
agents may be wisely combined. As a rule, the prognosis of chlorosis is 
unfavorable ; but if the general plan advised be pursued, then recovery is 
quite probable. Too rapid results must not be expected, as rarely will a 
permanent cure be accomplished in less than a year. 



PLETHORA. 

Plethora signifies either an increase in the total amount of blood or an 
excess of some of its normal constituents. It may not improperly be con- 
sidered a condition distinguished from anaemia by directly opposite quali- 
ties. One author says: "Individuals with a certain group of symptoms 
have, since remote times, been designated as plethoric, upon the assump- 
tion that the symptoms were due to an excess of blood. The symptoms 
referred to are an abnormal redness of the face and mucous membranes, 
fulness of the pulse, increase of the heart's impulse, with tendency to pal- 



PLETHORA. 251 

pitations, a sensation of warmth and of a fulness, — especially in the head 
and chest, — sometimes epistaxis (bleeding from the nose), and hemor- 
rhages from the different mucous membranes." 

Plethora may be, to a certain extent, hereditary ; the causes are, how- 
ever, more often acquired. Among the most prominent are over-eating and 
an excess of blood-forming food, idleness and luxurious habits, insufficient 
exercise, and the arrest of periodic hemorrhages. In this affection, the 
employment of medicines should, as far as possible, be dispensed with. 
They should only be resorted to when the necessities of business prevent, 
or the solicitations of indolence interfere with, strict control over the diet 
and habits of the individual. In such instances a saline laxative should be 
taken, and the stronger mineral spring waters are advised. If these are 
not sufficiently active, one or two compound cathartic pills at bedtime, and 
followed by a seidlitz powder in the morning, will prove effectual. 

Plethoric patients are advised not to partake of animal food more 
than once a day ; they should never indulge the appetite to satiety, and 
should forego the use of beer, spirits, coffee, and all stimulating beverages. 
Early rising is a habit which they will do well to acquire, and cold sponge- 
bathing should be daily practised. 



CHAPTER III. 

CORPULENCE. 

Corpulence, or an excessive accumulation of fat, known also as obesity, 
is a disease the importance of which is rarely correctly estimated. Even 
in the ordinary relations of life it is productive of evil results, exposing 
the patient to very considerable inconvenience and many social vexations, 
and the affection is only well borne so long as no extraordinary demand is 
made upon the functional and resisting power of the organism by some 
other grave disease. Considering the rapid advancement of the science of 
medicine, and the clearer knowledge acquired of diseases generally, it 
seems strange that physicians of modern times have given little attention 
to a morbid condition attended with so many dangers. Hippocrates, the 
father of medicine, recognized the evil results of corpulence, and among 
his writings are found prescriptions, as strict as they are concise, regarding 
the regimen to be maintained by "such as are desirous of becoming thin." 
A hard bed, hard bodily work early in the morning on a fasting stomach, 
a vegetable diet, especially green vegetables, after this work is done ; the 
diligent practice of running round in a circle every day, in the open air, 
in the costume of Adam, — these are the outlines of this antique method 
of cure. The modern system of treatment is based essentially on the 
same principle, and, if not as effectual, it is certainly milder and more 
pleasing. 

Corpulence may properly be considered a constitutional affection, a 
disease of general nutrition. The tendency to an excessive accumulation 
of fat is extremely variable in different individuals under circumstances 
outwardly the same ; some remain thin while others fatten to a morbid 
degree. Fat-production within the human system is a complex process, 
and many forces conspire to influence this physiological function. As yet 
neither the importance of the individual factors, nor the nature of them, 
is sufficiently understood, and the origin and development of corpulency 
must, for a time at least, remain problematical. There are certain influences 
which are recognized as predisposing to this disease. Among them may 
be included tendency by inheritance, peculiarities of constitution and tem- 
perament. The more common exciting causes are intemperance in diet and 

252 



CORPULENCE. 253 

in the use of spirituous liquors, insufficient exercise, and certain abnormal 
states of the system which are calculated to induce the disease in question. 

There are two forms of corpulency, characterized by distinctive condi- 
tions of nutrition ; they are called the plethoric and the ancemic. The 
former occurs most frequently in men in middle and advanced life, and 
they present unmistakable evidences of a plethoric habit. The cases of an 
anaemic type are more commonly observed in women, and they are char- 
acterized by distinct pallor of the skin, and other signs of impoverishment 
of the blood, or ansemia. Patients with plethoric corpulence have, as a 
rule, a better developed muscular system, greater appetite, and suffer less 
from digestive disturbances. On the other hand, those affected with the 
opposite type are less muscular, have but little craving for meat and other 
blood-forming articles of diet, and in them digestion is proverbially weak. 

Corpulent patients not only show a predisposition to a number of 
secondary affections, but, also, under exposure to other unusual influences, 
exhibit a generally less degree of tolerance than healthy persons. Their 
tendency to excessive perspiration is the cause of frequent " colds," and 
digestive disturbances more often follow indiscretions in eating. It is in 
the anaemic forms of corpulency of advanced life, that apoplectic seizures 
are frequent. There are many other complications and affections which 
appear in consequence of corpulency, among the most important of which 
are diabetes and cancer. It is an acknowledged fact that not only are the 
corpulent not exempt from any disease to which the thin are subject, but, 
also, in them all severe morbid processes, and especially all affections 
accompanied by intense fever, run their course with unusual malignity. 
Again, corpulent convalescents are comparatively slow in recovering from 
severe illnesses, and not infrequently in such instances restoration to health 
is but incomplete. 

Corpulency, when once developed, is usually a persistent affection. In 
the majority of cases, under well directed and prudent treatment, great 
improvement takes place, but no perfect cure of the condition can be 
expected excepting in rare instances. Unfortunately but few patients will 
he found possessing the energy of will necessary to sustain them through 
the treatment essential to effect even temporary improvement. In those 
cases which develop themselves under the influence of too luxurious living, 
with too little bodily activity, the prognosis is unfavorable, as the indulgers 
are, from the first, disinclined to comply with the rules of moderation 
which they must follow before the desired object can be attained. That 
even when recovery is apparently effected, a return of the disease will 
almost certainly take place, is a deplorable fact. Such a result can only be 
obviated by self-denial, and a renunciation of those improprieties of life 
which are influential in the over-production of fat. This statement might 
seem to the corpulent reader extremely discouraging, and yet it need not 
be so. It is not an unhappy future that is pictured for them if they 



'2CA DISK ASKS OF THE CIRCULATORY SYSTEM. 

attempt 8 cure, but rather one of infinitely greater comfort, and a longer 
life as well, attained by the sacrifice of merely a few imaginary pleasures 
and wanton excesses. 

In the treatment of corpulency, first in importance Is the reduction of 
immoderate indulgence at the table to within reasonable limits, and such 
as alone conduce to health. The quantity of food should be lessened 
gradually, not suddenly, and the deprivation will be much more easily 
borne. It should be reduced to the smallest quantity which can be taken 
and physical strength be maintained. It must not be forgotten that if too 
small an amount of food is allowed, a case of plethoric corpulency soon 
becomes the anaemic form of the same disease. Therefore, when the gen- 
eral strength is threatened, the limit of restriction is reached. 

Scarcely second in importance is the regulation of beverages. The use 
of water should be within the limits of moderation ; tea and coffee, with- 
out milk or sugar, are allowable, but if too strong they are highly detri- 
mental. Chocolate and cocoa should under all circumstances be avoided. 
The same may be said of malt liquors ; and if alcoholic stimulants are 
taken, the daily quantity must be exceedingly small. Acid wines are only 
permissible for daily use when much diluted with water. In this connec- 
tion a few words may be properly added on the use of tobacco during the 
treatment of corpulency. There is no reason to believe that a moderate 
indulgence in tobacco-smoking has any effect whatever on the ]:>roduction 
of fat, and it is neither recommended nor forbidden. 

A vigorous muscular action antagonizes the deposition of fat. It is, 
therefore, imperative that corpulent patients take a considerable amount 
of daily exercise. Not only are long walks advised, but also gymnastics 
which involve vigorous motions of the muscles of the upper extremities. 
It is no less important that over-exertion be avoided, as it would directly 
expose a corpulent person to the danger of serious heart trouble or an 
apoplectic attack. The cold shower-bath has a beneficial influence upon 
relaxed constitutions, and contributes much to success in the treatment 
of this disease. If these are not attainable, sponge-bathing should be 
employed daily. 

In cases of plethoric corpulency, the alkaline mineral waters are often 
serviceable. In anaemic forms of the disease the use of iron is urgently 
recommended. The number of proprietary medicines advertised as " sure 
cures " for corpulency are almost countless. That many are effectual in 
diminishing the deposition of fat, is acknowledged. Undoubtedly, these 
agents increase waste ; but many do so chiefly in consequence of a severe 
gastric catarrh which they set up. It is almost unnecessary to add that 
there is no known medicinal remedy, either alone or in combination, for the 
disease under consideration. Charlatans may reduce weight ; certainly in 
that they are successful, but the reduction is invariably dearly bought at 
the expense of the general health and constitution. 



CORPULENCE. 255 

The best and most approved dietetic treatment for the diminution and 
removal of the higher degrees of corpulency is that invented by Harvey, 
first tried with good results upon W. Banting, and christened, after the 
latter, the "Banting System." Under the form of diet which Banting 
adopted for one year, his weight fell from two hundred and two pounds to 
one hundred and fifty-six pounds ; the circumference of his body at the 
same time diminishing about twelve and one-quarter English inches. At 
the same time there was improvement in his general health, greater ease 
in bodily movement, especially in ascending heights, etc. The reduction 
of the corpulence was a radical one to this extent : Banting, after seeing his 
weight and bodily circumference reduced to nearly the normal standard, 
for the sake of experiment returned, for a while, to all forbidden foods and 
beverages (except beer), without suffering from a return of the corpulence. 
Mr. Banting's dietary table, he states, was as follows : — 

"For breakfast, at 9 a.m., I take five or six ounces of either beef, mut- 
ton, kidneys, broiled fish, bacon, or cold meat of any kind, except pork or 
veal; a large cup of tea or coffee (without milk or sugar), a little biscuit, 
or one ounce of dry toast; making together six ounces solid, nine liquid. 

"For dinner, at 2 p.m., five or six ounces of any fish except salmon, 
herrings, or eels; any meat, except pork or veal; any vegetable, except 
potato, parsnip, beet-root, turnip, or carrot; one ounce of dry toast; fruit 
out of a pudding not sweetened ; any kind of poultry or game ; and two 
or three glasses of good claret, sherry, or madeira — champagne, port, and 
beer forbidden ; making together ten to twelve ounces solid, and ten 
liquid. 

" For tea, at 6 p.m., two or three ounces of cooked fruit, a rusk or two, 
and a cup of tea, without milk or sugar ; making two to four ounces solid, 
nine liquid. 

" For supper, at 9 p.m., three or four ounces of meat or fish similar to 
dinner, with a glass or two of claret, or sherry and water; making four 
ounces solid and seven liquid. 

"For nightcap, if required, a tumbler of grog (gin, whiskey, or brandy 
without sugar), or a glass or two of sherry or claret." 

Within the past few years, several works have been written on the 
subject of corpulence. The various authors have differed somewhat on 
minor details, but the treatment which they advise is practically the same 
as that which proved so successful in Banting's case. Some have felt that 
the exclusion of fat from the diet was useless, and even insisted that 
patients indulge in it to an excessive degree. Doubtless the effect of an 
undue proportion of fat is to impair the appetite, and the treatment then, 
in many instances, becomes nothing more or less than a hunger-cure. 

In concluding the discussion of corpulency, the writer will briefly refer 
to his personal experience in reducing his own weight. He originally 
weighed two hundred and twenty pounds, and by a rigid observance of 



256 DISEASES OF THE CIRCULATORY SYSTEM. 

dietetic rules similar to those which Banting followed, his weight in six 
months fell to one hundred and eighty pounds. For the next two months 
the decrease was scarcely perceptible, and, to secure a still greater reduc- 
tion, he made a radical change in his manner of living, and for a time, 
upon the plains of western Texas, he shared the pleasures and the hard- 
ships of frontiersmen. The effects of this wild and exciting life upon 
corpulency were soon markedly evident ; in three months there was an addi- 
tional loss of twenty pounds, and his weight had then fallen to one hundred 
and sixty pounds. During this period physical strength was not only 
maintained but increased, as the test finally applied gives abundant proof. 
From the camp of the writer to the nearest railroad was about one hun- 
dred and eighty miles; this distance, although the days were the shortest 
of the year, he covered on horseback in two and one-half days. Con- 
sidering the fact that Broncho ponies are by no means invariably easy under 
the saddle, the journey in the time occupied required no little endurance. 

Possibly of additional interest may be a mention of the character of 
the food eaten during this sojourn in the West. The diet consisted princi- 
pally of bacon and " camp-bread " ; the latter w r as composed of flour and 
water, to which was added a minute quantity of baking powder. This 
mass, after being but indifferently kneaded, was formed into round cakes, 
which were cooked in a frying-pan on live coals. The bacon, in cooking, 
was not long submitted to heat; being very rich in fat, but little else 
remained if the process was prolonged. Fresh beef was esteemed a luxury, 
and rarely indulged in. Game was by no means plentiful, and only occasion- 
ally secured. Potatoes were the only vegetables to be obtained, and, the 
supply being exceedingly small, probably no oftener than once a w~eek w T ere 
they eaten. A few cans of preserved peaches reached camp ; these were 
the only sweets, as the native sorghum proved anything but agreeable to the 
taste. The common beverage, coffee, contained neither sugar nor milk; 
the latter is rarely indulged in on the frontier. 

Thus, on a diet composed largely of bread and fats, the writer, amid 
changed surroundings, living an active life, spending some hours in the 
saddle each day, reduced his weight twenty pounds. This case, in which 
fats were freely and in large quantities eaten, and yet loss in weight went 
on, is an isolated one, and can add but little to the support of the now pop- 
ular theory that oily matters need not be excluded from the diet of the 
corpulent. It is, however, safe to assert that fatty food has less influence 
upon the disease than was formerly supposed. 



SECTION III. 
DISEASES OF THE DIGESTIVE SYSTEM. 



CHAPTER I. 

DYSENTERY. 



Dysentery is a specific febrile disease, characterized by an inflamma- 
tion of the mucous membrane, and often of the deeper tissues of the large 
intestine. That portion of the intestinal canal is about five feet in 
length, and describes an arch, which commences in the right side of the 
abdomen and passes across to the left, and descends to the external open- 
ing of the body. In mild cases the disease is confined to the lower 
portion of the large intestine, while in severe cases it affects its entire 
length. It may be acute or chronic, sporadic or epidemic. The essential 
difference between the last mentioned and simple or sporadic dysentery, 
is that, in the epidemic form, extensive ulcerations are more apt to occur, 
and a much larger number of persons are attacked in the same locality. 

The disease common^ begins with a simple diarrhoea, the dejections 
being yellow or brown, and from two to six daily. With them there is 
moderate colicky pain ; the appetite, sometimes unaffected, is usually 
impaired, the tongue furred ; there is a general feeling of malaise, and 
often, in the severer cases, one or more attacks of vomiting occurs. During 
this stage, the patient remains out of bed, and in many cases attends to his 
usual occupations. After a period, varying in different cases from twenty- 
four hours to seven days, the diarrhoea becomes suddenly more severe. A 
pronounced chill rarely occurs, but chilly sensations, with some fever, 
general discomfort, and weakness, usher in this stage. The abdominal 
pain is more intense, and the attacks frequent and violent. The inflam- 
mation of the rectum occasions a sensation as if that portion of the bowel 
were filled, and there is a constant desire to defecate, which the patient- 
can resist but for a few moments. With violent straining and burning 
pain, only a small quantity is expelled. The evacuations soon contain 
blood and mucus, in the form of gelatinous masses, having the peculiar 
dysenteric odor. Progressively the strength is reduced, the patient 

257 



DISEASES OF THE DIGESTIVE SYSTEM. 

becomes nervous, anxious, irritable, and restless: his face is pale, and his 
countenance expressive of great distress. Headache, dizziness, loss of 
sleep, want of appetite, and burning thirst, add much to the intensity of 
the Bufferings. 

Aa the disease advances, in the severe type the evacuations change in 
character: in some cases they are brownish and very watery, others 
containing matter in appearance like ''washed raw meat"; not infre- 
quently they are greenish-black in color, and give off an exceedingly 
offensive odor. The abdomen soon becomes distended and tender; the 
pulse increases in frequency, and is small and feeble. The tongue, at first 
moist, and covered with a whitish fur, becomes dry, its edges red, and its 
centre brown or black. As a rule, the intellect is unaffected; mild delirium 
at night is occasionally observed. If the case tends to a fatal termination, 
the discharges, no longer controlled, have a putrid, gangrenous odor; there 
are attacks of fever, followed by remissions ; physical strength is exhausted ; 
finally collapse comes on, and hiccough, picking at the bedclothes, cold 
perspiration, a flickering pulse, deeply sunken eyes, lividity of the face and 
extremities, hoarse voice, and distress in the region of the heart, are the signs 
indicative of rapid dissolution. Consciousness is usually retained to the end. 
If recovery takes place, the discharges during the second week become less 
frequent, and are attended with but little straining. The fever subsides, 
the pulse diminishes in frequency, and grows stronger, the abdominal ten- 
derness and distention disappear, and the evacuations assume a normal 
odor and appearance. The appetite and strength slowly return, and. 
during convalescence, the face loses the anxious, despondent look which it 
wore during the active period of the disease. 

Cceasation. Dysentery, when it prevails as an epidemic, affecting a 
large number of people, and spreading within definite limits, is doubtless 
developed by a specific miasm. This excitant of the disease owes its prop- 
agation to a combination of favorable influences, doubtless depending upon 
the climate, temperature, season, and situation. Whether the dysenteric 
poison is transferable from one person to another is a question in dispute. 
That there is a limited contagion by means of the intestinal discharges is 
highly probable; and where the epidemic form of the disease prevails, every 
dejection from patients should be considered dangerous. 

Sporadic dysentery must be regarded as arising from local causes, and, 
in its origin, it essentially differs from the epidemic form. Atmospheric 
changes, excess in eating and drinking, irritating food, — such as unripe 
fruit, or vegetables tainted by decay. — a diet wanting in vegetables, intem- 
perate use of alcohol, great mental disturbance, torpidity of the bowels, 
and excessive fatigue, are among the predisposing causes. Often dysentery 
is excited by drinking water essentially different in its constituents from 
that to which the patients are accustomed. The writer recalls one instance 
where the disease occurred unmistakably due to this cause. While he was 



DYSENTERY. 259 

attached to a United States steamer, cruising in the tropics, the condenser, 
through which all the drinking-water was obtained, became unserviceable, 
and for a time the tanks were rilled from a spring on the island of Mar- 
tinique. The change was felt at once, almost every man aboard being 
attacked with diarrhoea, which, in many cases, in a very short time ushered 
in dysentery. The disease assumed an alarming type, and in several 
instances proved rapidly fatal. 

Prognosis. Simple sporadic dysentery is attended with little danger 
to life, excepting in young children and the aged. In the milder cases, 
convalescence begins after from eight to thirteen days, and recovery is 
complete in about three weeks. The duration of the disease in cases of 
epidemic dysentery is very variable. In some epidemics, the majority of 
the cases are mild, and the rate of mortality is very small. Occasionally 
the disease assumes a malignant type, and in such death may occur in the 
course of a few hours, or the disease be protracted some weeks before either 
that misfortune is experienced or convalescence takes place. The most 
severe cases, excepting in the tropics, rarely terminate fatally during the 
first week. It is aptly said that the longer a severe case runs on, the more 
favorable it is for the patient ; the longer a light case, the less favorable. 
Hope of recovery should never be abandoned until the worst stage of col- 
lapse is reached. A putrid condition of the intestinal discharges, great 
loss of blood, extreme restlessness, picking at the bedclothes, and other 
nervous symptoms and indications of collapse, are the prominent signs 
which render the prognosis unfavorable. Chronic dysentery is one of the 
most obstinate and hopeless of diseases; its duration embraces several 
months, and sometimes years. 

Treatment. A patient suffering from dysentery should be confined to 
his bed, in a comfortably warm, well ventilated room. All clothing and 
linen should be scrupulously clean, and frequently changed. Careful disin- 
fection of the air of the sick-room, and all vessels, as well as the discharges, 
is important, especially in epidemic dysentery. The diet should be chiefly 
milk and lime-water, uncooked beef-juice, egg and water, and light meat- 
broths ; no solid foods should be allowed. Drinks lukewarm are most easily 
borne; cold fluids generally cause abdominal pain. Stimulants should 
only be administered by the advice of a physician ; they are rarely needed, 
excepting in the most desperate cases. When the thirst is excessive, barley- 
water or gum-arabic water are palatable and refreshing. During conva- 
lescence, the diet is to be most carefully regulated, and when the patient 
begins on solid food he should indulge only in the white meat of fowls, 
delicate fish, and very light puddings. 

The first step in the medicinal treatment is to remove, as early as pos- 
sible, all irritating matter from the bowels by a cathartic. To accomplish 
this, half an ounce of Rochelle salts, or a like quantity of either Epsom salts 
or Glauber's salts, in water, is sufficient. Castor-oil is held in high repute as 



260 DISEASES OF THE DIGESTIVE SYSTEM. 

an appropriate remedy, but, being exceedingly disgusting to many, its use 
need not be insisted upon. As soon as the cathartic has acted, twenty-five 

drops of laudanum, or one grain of opium, should be given, and in many 
instances, it a proper diet is rigidly adhered to, no further treatment will 
be needed. If, after the effect of the opiate passes off, pain, straining, 
and the voiding of mucus from the bowels are renewed, then the same 
remedies are to be repeated. This treatment, if applied early in the attaek, 
i-> rarely unsuccessful, and by it the dysentery is converted into a simple 
diarrhoea. In occasional instances the mucous and bloody discharges, 
instead of stopping under the use of the cathartics, are as constant or 
become more profuse than before ; in rare cases, the pain and straining are 
more distressing. The treatment then to be employed is the continuous 
administration of an opiate; the following combination will prove the 
most efficacious : — 

Jfc Acid, carbolici gr. v. 

Morphise sulph gr. ij. 

Sodse sulphatis 3 il J- 

Aq. cinnamon 3 ij. 

Ft. mist. Sig. : Dose, one teaspoonful. 

This preparation should be given, in the dose directed, every three or 
five hours, as is needed to control the pain. At first the discharges will 
show but slight decrease in frequency, but usually within forty-eight hours 
the pain will have subsided and the straining been entirely overcome, after 
which the number of dejections will slowly lessen. 

In some cases of dysentery, the patient is suddenly seized with slight 
chilliness, followed by pain, straining, and great prostration. The pulse 
is small, feeble, and rapid ; the skin cool, covered with sweat described as 
oily ; and the discharges present an aj^pearance characteristic of this form 
of the disease ; they are of mucus, having the exact color of hickory 
ashes. In this formidable condition, Dr. Buckler says, " Nothing is required 
but to give five grains of capsicum every three hours. By the time, or 
before, six of these pills have been taken, a profuse flow of bile will come 
away, changing entirely the character of the stools, from gray mucus to 
bile, but improving the condition so much that return of strength and 
convalescence are at once established." 

Rarely will any other medicinal treatment than that already advised be 
needed, in the majority of cases of dysentery, excepting in those assuming 
the so-called malignant type. In this severe form, in many instances 
will treatment prove unsatisfactory ; to support the patient with concen- 
trated nourishment and stimulants, is of paramount importance. Rectal 
injections, in some cases of dysentery, prove highly effective, and starch- 
water has in times past been the popular remedy. If it is deemed neces- 
sary to use them, the most gratifying results will be attained with bismuth ; 



ENTERITIS. 261 

from ten to twenty grains may be administered in gum-arabic water, after 
every evacuation. 

In summing up the treatment of dysentery, the efforts are to be 
directed, not merely to lessening the number of discharges, but rather to 
correcting the condition of the bowel which induces them; as the inflam- 
mation there subsides, the evacuations will be more infrequent. If the 
pain and straining are abating, the disease is progressing favorably, even if 
the number of discharges decrease slowly. Patients must assist the treat- 
ment, and seek to control the promptings which are so constant and diffi- 
cult to resist. The use of the cathartics, already referred to, is appropriate 
in all forms of dysentery in the early stage ; they should be given cau- 
tiously, or omitted, if the dejections are very watery, of the color of blood, 
and devoid of mucus, or if the symptoms denote rapid failure of the vital 
powers. In such cases, the opiate mixture must be depended upon, and 
given every three hours unless signs of narcotism are observed. Alcoholic 
stimulants and concentrated nourishment will also be needed, and 
large quantities of the former are usually well tolerated, even by patients 
unaccustomed to their use. 



ENTERITIS. 

Enteritis is an inflammation of the mucous membrane of the small 
intestine. This membrane becomes reddened and swollen, and from its 
surface a copious exudation is given off, which, combining with the 
increased flow of intestinal juices, is hurried downward by a more active 
movement of the bowel excited by the inflammation, and causes loose, 
watery discharges. The disease may be either acute, sub-acute, or chronic, 
according to its intensity and duration. 

Symptoms. The most important and characteristic symptom of acute 
enteritis is diarrhoea, and unless the inflammation is extremely limited, this 
is never absent. According to the severity of the inflammation, the dis- 
charges vary in frequency, from four to ten, or even more, daily. In char- 
acter they also vary ; in mild attacks the evacuations are thin, pulpy, and 
otherwise natural in appearance ; in severer cases they change to a water)', 
greenish-yellow, or, finally, an entirely colorless fluid. Unless the inflam- 
mation involves the large intestine, blood and mucus do not appear in the 
diseharges. A common, but less constant, symptom than diarrhoea is 
abdominal pain. It is not intense ; sometimes it is remittent and colicky, 
sometimes of a dull, aching character, and is aggravated by deep, firm 
pressure. Tenderness exists over the abdomen, but is not great, and slight 
pressure is well borne. Vomiting is more or less prominent as a symptom, 
and jaundice occasionally occurs. In severe acute cases fever is present, 
sometimes ushered in with a chill and accompanied by headache, loss of 
appetite, acceleration of the pulse, and the usual general signs of an 



MS »F THE DIGESTIVE SYSTEM. 

inflammatory disturbance. When the disease progresses favorably its dura- 
tion is brief, convalescence commencing in from a week to ten days. 

Causation. The intestinal mucous membrane is particularly liable to 
inflammation: the exciting causes are therefore extremely numerous. 
Enteritis may be produced by dietetic excess, coarse, indigestible food, 
unripe fruit, which has been imperfectly masticated, bad drinking-water, 
alcoholic stimulants, poisons, and medicines such as colocynth and other 
powerful purgatives. It is also attributable to worms and obstinate con- 
stipation. Another common cause is the influence of cold upon the body 
when heated and perspiring. Contusions of the abdominal walls are some- 
times followed by intestinal inflammation. The affection is often associated 
with diseases of the liver, heart, lungs and kidneys; it also occurs some- 
times after severe burns. 

Diagnosis. Acute enteritis cannot easily be mistaken for any other 
affection: those with which it is liable to be confounded are dysentery, 
colic, peritonitis, and typhoid fever. The characteristic dysenteric evacua- 
tions and straining being absent, the first disease mentioned is readily 
excluded. Colic is a functional disorder, occurring in paroxysms ; it is 
never attended by tenderness or fever, and rarely by diarrhoea, but more 
often by constipation. In that affection, also, Arm, steady pressure on the 
abdomen is not only well borne, but often relieves, somewhat, the pain. 
Peritonitis is a rare and grave disease, characterized by symptoms of great 
intensity. The constitutional disturbance is much greater in that affection 
than in enteritis ; constipation is also the rule, and the abdominal muscles 
are contracted and rigid. Typhoid fever ought not to be mistaken for 
intestinal inflammation, as there are but few symptoms, in common. In 
doubtful cases the thermometer will show the course of the temperature to 
be characteristic of the former disease. 

Prognosis. Acute enteritis, unassociated with any other important 
affection, occurring in adults previously strong and healthy, usually ter- 
minates in recovery. It may justly be considered a serious disease in very 
young children and in advanced life. The most dangerous locality for the 
occurrence of the inflammation is at the junction of the large and small 
intestine, in which situation the disease is called typhlitis. Chronic ente- 
ritis rarely follows the acute form, and usually owes its origin to some 
prior morbid condition. It is a common consequence of chronic diseases 
of the more important abdominal organs. 

Treatment. A patient suffering from acute enteritis should be com- 
pelled to remain in bed until convalescence is assured. The diet should be 
rigidly restricted to milk and lime-water, barley-water, the yolk of eggs, 
beef juices and light broths. No fatty food is allowable, or bread, or any 
other form of starchy food. Next to the regulation of the diet, the most 
important measure is the removal of all irritating substances from the 
intestinal canal. To this end a cathartic dose of castor-oil should in every 



ENTERITIS. 263 

instance be administered. This precaution must never be neglected, even 
when diarrhoea is present. Opium is the medicinal agent to be depended 
upon, and small doses usually suffice ; one-half a grain should be given 
every two or three hours, and its use continued until the diarrhoea ceases. 
Applications of mustard to the abdomen are appropriate, and, if the pain 
is excessive, fomentations by means of poultices or water-dressings are use- 
ful. If the loss of strength is great and marked prostration is threatened, 
stimulants may be carefully administered ; a more nutritious diet will also 
be indicated. As the active symptoms subside, the food should still be 
restricted to those articles easily digestible. In chronic enteritis the indi- 
cation is to remove, if possible, the cause. This involves in many cases the 
treatment of the prior morbid condition which gave rise to it. 



CHAPTER II. 
PHARYNGITIS. 

The pharynx is that part of the alimentary canal which is placed 
behind the nose, mouth, and the upper part of the air-passage. An 
inflammation of the mucous membrane lining the inner walls of this cavity 
is called pharyngitis. It may be acute or chronic, and may affect all 
or be limited to only portions of the pharynx. When the acute inflam- 
mation involves the tonsils, it constitutes the affection called tonsillitis. 
In acute pharyngitis the soft palate and the uvula usually participate in 
the inflammation, which not infrequently extends into the mouth, and the 
upper part of the air-passage. It seldom occurs alone as a primary affec- 
tion ; more often there is an acute catarrh of the nasal passages. " Catch- 
ing cold " is in most cases adduced as the cause, as the affection usually 
follows exposure. Some people seem to be predisposed to the disease, 
and one attack creates a liability to others. It sometimes assumes an 
epidemic character, and prevails in certain localities for weeks, declining 
gradually and at length disappearing. 

Chronic pharyngitis may follow immediately the acute form, or proceed 
from recurrences of the same. It may also be caused by poisonous 
exhalations, by the excessive use of tobacco and spirituous liquors, and by 
prolonged speaking or singing. It is more frequent in man than in 
woman, and occurs more often after maturity and in middle life. Of this 
disease Flint says: "The number of persons is very large in this country 
who overtask the powers of the system by steady labor in the office, the 
counting-house, or the workshop, continued without intermission for 
many years, giving no time whatever to recreation. It is among those 
who in this way violate the laws of health that this affection prevails. It 
seldom occurs among the so-called laboring classes, and it is much more 
frequent in cities than in the country. It is accompanied with symptoms 
denoting impairment of the general health. Patients complain of debility 
and a want of their accustomed energy; they are generally depressed in 
spirits, and have forebodings of loss of health ; they are very apt to fancy 
the existence of some serious disease, especially pulmonary consumption, 
and it is sometimes difficult to persuade them that the latter disease does 

264 



PHARYNGITIS. 205 

not exist. Dyspeptic ailments frequently co-exist. Palpitation of the 
heart is not uncommon. " 

The milder cases of acute pharyngitis are not characterized by any promi- 
nent manifestations. Severe attacks of the affection are often preceded 
or attended by slight fever. The throat becomes dry, reddened, and 
swollen; there is a sensation of tightness, and swallowing is painful and 
difficult. The voice is altered, and, if the nasal passages are involved, 
respiration through the nose is impeded. The inflammation not infre- 
quently extends up the Eustachian tube, and more or less deafness results. 
It sometimes affects the mucous membrane of the tonerue and mouth, 
adding much to the discomfort of the patient. The elongated uvula 
seems to fill the throat, and not infrequently excites violent fits of cough- 
ing. There are occasionally present dulness and heaviness in the head, 
and pains in the upper part of the neck. In the further course of the 
disease these symptoms soon subside, and there is a profuse secretion of 
mucus, poured out from the affected membrane ; this provokes frequent 
hawking, gagging, and spitting. The mildest cases last but for a few days ; 
those of great intensity, associated with pronounced swelling, sometimes 
continue for several weeks. If acute pharyngitis passes into the chronic 
form of the disease, the upper part of the air-passage participates in the 
inflammation ; there is hoarseness, sometimes partial loss of voice, cough, 
and thick, tenacious mucous expectoration, often containing small, firm, 
yellow masses. In the throat there are sensations of dryness, rawness, 
tickling, disposition to hawk, cough, etc., and in many instances the hear- 
ing is impaired, and ringing noises in the ears are a source of great 
annoyance to the patient. These symptoms are all aggravated by sudden 
atmospheric changes, " catching cold," excessive smoking, and indulgence 
in spirituous liquors, more especially if the latter are taken undiluted. 

Acute pharyngitis is a very mild affection, and recovery often follows 
in a few days. In severe cases, the duration may be from one to two 
weeks — seldom longer. Chronic pharyngitis is one of the most obstinate 
of diseases, persisting even for }-ears. There is a popular prejudice, 
founded upon the assertions of charlatans, that this affection eventuates in 
disease of the lungs. It has no tendency whatever to do as they state; in 
fact, patients with pharyngitis rarely become consumptive, and the exist- 
ence of the former is, to some extent, evidence of the non-existence 
of the latter. 

In mild attacks of acute pharyngitis, there is no necessity for special 
treatment. In severe cases a cathartic may properly be administered, and 
a foot-bath employed. A wet-pack should be applied to the throat, and it 
may be either hot or cold, as the patient prefers, but they must not be 
alternated. For the inflammatory swelling of the mucous membrane, 
small pieces of ice may be swallowed and iced drinks indulged. Advan- 
tage will also be derived from frequently repeated gargles of a solution of 



DI> - - F THE DIGESTIVE SYSTEM. 

the chlorate sh. The liability of recurrences 

attack has rienced, must i _ . very 

takes place there should be tnce of ordinary injurious intiu- 

inking, unnecessary breathing throagh the mouth, 
rtion in speaking. System ight :.:ade 

to render the skin less bus ad t this end - 

bat: - daily employed. Freedom from attacks will depend no 

little upon t: ss _ : the neck : radical changes in the m - ich as 

stituting a turned-down for a standing collar, are quite certain to be 
followed by throat-irritations. 

In the treatment of chronic pharyngitis, local applications are : 

a should 1 1 to the improvement of the _ 7 .- 
eral system. A rigid observance of hygienic laws is of first importance. 
As ne author states: u Relaxation, recreation, and out-of-door life are fai- 
ns than medi 5, ind the latter are of little use without the 

: ..-. When circumstances permit, relinquishment of business for a 
time, for travel or rural occupations, is :: ^_nal benefit.' 7 The use of 
tonic remedies is in nearly all cases indicated, and they should be | a sist 3 
in; in fact, the object of treatment is :: : est .- :"ae general health. 

TONSILLITIS. 

T asillitis is an inflammation of the tonsil, commonly known as rinsy 
sc . thi :' There are different forms >f this iisease; :: maybe acute 
or chronic, attack both tonsils or be limited to one; in some, the glandular 
structure is involved. A more extended . ssificati : the Tri-ent 

inflammations of the t nsils is possible, it it :s unnecess 
create confusion. It is sufficient to special". sidei twe forms .: acute 

tonsillitis, the simple, n _ . -'.iaL and the foil 

In superficial tonsillitis, the general symptoms s ight, or absent 

the disease is manifested principally by local disturbs:, as . : ying inten- 
_ere is a feeling of listention or pain in the throat, increasing on 

-are and movements of the tongue, neck, and head. Sw Uowing is 
difficult and painful, and maybe almost impossible for some days. Not 
infrequently there is difficulty in opening the mouth, attempts to move the 
jaws causing darting pains, which shoot up to the e a T . voice has a 
peculiar nasal tone ; speech is painful and incomprehensi'"r. Mucus and 
- * reted, and flow out of the mouth, which is kept 
partially open, to enable the patient to breathe, the nasal passages bei _ 
obstructed by the inflammation. There is. in - sases, a sens 

impending suffocation, especially on lying down, and _ slee| is 

"e. 

- - ;dled follicular tonsillitis is a disease characterized bv constitu- 
tional symptoms of great intensity. It is quite equally distinct from 



TONSILLITIS. 267 

pharyngitis and superficial inflammation of the tonsil. The invasion is 
usually sudden, marked by sensations of chilliness, or a distinct chill fol- 
lowed by high fever, thirst, loss of appetite, sometimes vomiting, and 
occasionally bleeding at the nose. There is some headache, backache, 
extreme prostration, and weakness. The local disturbances in the throat, 
in some cases, are manifested before the constitutional symptoms become 
pronounced; in others they follow them, being usually slight at first, and 
increasing rapidly in severity. There is no constant relation between the 
local inflammation and the general disturbance, as the former may be 
trifling when the latter is most severe. The converse of this is also true, 
that, along with a severe local inflammation, the constitutional symptoms 
may be only of moderate intensity. The tonsils are reddened, more or 
less enlarged, and their surfaces are dotted with small white spots, Avhich 
mark the mouths of the follicles or ducts obstructed by the inflammation, 
and from which, after a time, the confined secretion bursts forth. In this, 
as in other forms of tonsillitis, the local inflammation gives rise to 
much the same symptoms — pain, difficulty in swallowing, changes in the 
voice, etc. 

Writers of medical literature have, without discussion, assumed acute 
follicular tonsillitis to be a purely local disease, to which the attendant 
general disturbances were subordinate. There are certainly grave doubts 
as to the validity of this theory, and reasonable grounds for considering 
the affection a constitutional fever, of which the sore throat is but a local- 
ized expression. Herein is one of the essential differences between super- 
ficial tonsillitis and the follicular form. In the former, in the majority of 
cases, the inflammation occurs in the throat, and the general symptoms, 
fever, etc., are secondary to it. On the other hand, in follicular tonsillitis, 
the system is primarily attacked by a constitutional fever, characterized by 
an inflammation in the throat, in which the tonsils and mucous membrane- 
are chiefly involved. This disease is capable of producing in a very short 
time great prostration and an appreciable loss of flesh. The duration 
of the urgent symptoms is from four to five days; usually, on the 
eighth day convalescence commences, and the patient very soon entirely 
recovers. 

Acute follicular tonsillitis occurs in an epidemic form, and is more or 
less infectious. Doubtless it will yet be proved that the exciting cause is 
a specific poison, and the affection will be included in the class of so-called 
germ-diseases. Considering its self-limited character, efforts to cut short 
an attack will rarely, if ever, be successful. To lessen the constitutional 
disturbances, is, however, possible, and measures to that end should be 
employed. If the fever runs high, a sweat is advised in the beginning of 
an attack, and the tincture of aconite-root is the most efficient agent to 
employ for this purpose. Five drops should be given, in divided doses. 
These may be added to a wine-glass of water, and one-third of the quan- 



268 DISEASES OF THE DIGESTIVE SYSTEM. 

tity taken immediately, one-half the remainder in half an hour, and the 
vest in an hour. Five grains of Dover's powder should then be adminis- 
tered, and extra blankets added to the usual bedelothing. Two hours are 
generally sufficient in which to excite profuse sweating, which will be 
hastened by drinking water quite freely. At the end of that time the 
patient may be dried and allowed to change to the dry side of the bed. 
This treatment always measurably relieves the sore throat, and the back- 
ache and pains in the limbs and head rapidly disappear. The following day 
the patient will feel much improved, although some soreness of the throat 
generally persists for a few days; milk and other liquids can, however, be 
taken with comfort. Constipation, which usually follows the treatment 
described, can be relieved by a seidlitz powder, or a mora active cathartic. 
Garbles of hot water should be used, until the inflammation in the throat 
lias entirely disappeared. A nutritious diet will be needed, and two grains 
of quinine, three times daily, should be taken as a tonic, until recovery is 
completed. 

Abscess of the tonsil is of frequent occurrence, and few inflammatory 
affections are attended with greater discomfort. It is possible to occur as 
a complication in all forms of tonsillitis, and its existence in the early 
stage it is difficult to determine. Abscesses may form in both tonsils at 
the same time, one only may be affected, and in a tonsil there may be one 
or several abscesses. If in a case of tonsillitis the general and local symp- 
toms, under proper treatment, do not tend to subside, but the latter espe- 
cially become more intense after the third day, then the formation of an 
abscess is highly probable, and the diagnosis can be made with certainty if 
the tonsil continues to enlarge. There is greater pain, increased difficulty 
in swallowing, etc. The treatment in such cases is to hasten suppuration, 
as no improvement is possible until the abscess discharges. Warm poul- 
tices of linseed meal are external applications most eflicacious and agree- 
able, and gargles of very hot water hasten the process. The much 
recommended timely opening of tonsillar abscess is of little use, because it 
is very seldom successful ; and even when it succeeds it hardly ever relieves 
the patient. Again, when once an abscess has commenced to form, there is 
no means whatever of arresting its progress. To support the patient by a 
highly concentrated and nutritious diet is of great importance ; to relieve 
pain and promote sleep, opiates should be administered. Possibly, stimu- 
lants will also be demanded. The local symptoms and constitutional dis- 
turbance will increase for several days, and then, in occasional instances, 
gradually subside, but more often something is felt to give way in the 
throat, and suddenly the patient is entirely relieved by the discharge of 
fetid yellow pus. Convalescence is then rapid, and recovery soon takes 
place. 



PAROTITIS. 209 



PAROTITIS. 



Parotitis, or " mumps," is a painful enlargement of the parotid gland. 
This gland, so called from being placed near the ear, is the largest of 
the three salivary glands, and lies upon the side of the face, immediately 
below and in front of the external ear. This affection usually attacks the 
left parotid first, but with few exceptions both glands become involved, 
although the one first affected suffers the most. 

Parotitis runs an acute course, and in most cases subsides without 
leaving any traces behind. It is contagious, and usually makes its appear- 
ance in from seven to fourteen days after exposure. The symptoms 
which usher in attacks are variable, and in no wise characteristic. In 
the majority of cases, for a short time, generally from one to two days, 
there are chilly sensations, followed by flashes of heat, feelings of depres- 
sion, dull pains in the limbs, headache, loss of appetite, and possibly 
distinct fever, which usually comes on towards evening. The commence- 
ment of the glandular swelling is indicated by a sensation of stiffness 
about the angle of the jaw, and stitch-like pains spreading over that 
portion of the face near the ear. These are increased by movements of 
the jaw, by speaking and by chewing, as well as upon pressure. Very 
soon the swelling becomes plainly evident; it is beneath the lobe of the 
ear, and extends into the cheek upwards towards the eyes, forwards 
towards the corner of the mouth, and downwards into the neck. After 
both glands become affected, the circumference of the neck sometimes 
exceeds that of the head. With such a swelling, the expression of the face 
is entirely changed, and the appearance has been described as idiotic. 
Often the throat becomes affected by the inward extension of the 
swelling, and the result is a further increase in the difficulties in chewing 
and swallowing. The voice is changed, the tone nasal, and, in rare 
instances, there is a sense of suffocation. In severe cases, opening the 
mouth is for some days entirely impossible ; hardly can the point of a 
teaspoon be forced between the rows of teeth. Not infrequently are 
added to the symptoms already described, impaired hearing, ringing in the 
ears, and salivation. Men sometimes suffer from painful complications, 
the duration of which is similar to that of mumps. 

The course of parotitis is, as a rule, favorable ; the disease reaches its 
height in from three to six days, and the swelling of the glands begins to 
subside on the seventh or eighth day. Parotitis occasionally occurs 
during the course of certain constitutional diseases, especially those due to 
infection. In such cases the gland generally suppurates, and if the pus is 
not evacuated by an incision, it discharges through the skin, or into the 
mouth or throat. This form of the disease, occurring in the course of 
any acute general disorder, must be regarded as a very unfavorable 
symptom. 



270 DISEASES OF THE DIGESTIVE SYSTEM. 

Simple parotitis does not, ordinarily, require any medicinal treatment. 
Avoidance of injurious influences, such as exposure to cold, is essential ; the 

patient should be kept in an even temperature, and, as constipation usually 
exists, a mild laxative will be needed. The diet should be bland and unstim- 
alating. Generally, hot local applications are agreeable, and the so-called 
"hop-bag" is the most suitable. When parotitis occurs as a complication 
it should be treated as an abscess, and suppuration hastened by ]:>oultices 
of linseed meal. 



SECTION IV. 
DISEASES OF THE STOMACH AND INTESTINES. 



CHAPTER I. 
DYSPEPSIA. 



Dyspepsia, or, in the literal sense of the word, difficult digestion, does 
not indicate an independent disease, but only a group of symptoms com- 
mon to a variety of affections of the stomach, caused by a functional 
derangement of the processes of digestion. In dyspepsia the act of diges- 
tion is not only retarded, but also accompanied by numerous local and 
general affections. The symptoms of the affection are many, and vary 
not only in different individuals but in the same individual at different 
times. As one author says : "In certain cases the processes of digestion 
appear to be fully accomplished, but they are accompanied with uncom- 
fortable sensations. In healthy persons, as is well known, a good digestion 
is productive of a sense of comfort. It is quite the reverse in some dys- 
peptics. They are often uneasy or miserable while the digestive processes 
are going on ; they complain of uneasiness in the stomach or intestine, of 
a sense of distention, and of a general sense of discomfort. And these 
symptoms may afford the only evidence of disorder. The food appears to 
be digested, and the body may be well nourished, whereas, in other cases, 
these symptoms are associated with those denoting imperfection or dis- 
turbance of the digestive processes. On the other hand, when digestion 
is incomplete or disturbed, various symptoms arise in different cases, and 
with these there is sometimes comparatively little suffering. It is a 
curious apparent inconsistency that some persons manifest habitually more 
or less derangement of digestion without much annoyance, while other 
persons habitually digest perfectly but pass a wretched existence." 

One of the most constant symptoms of dyspepsia is an abnormal appe- 
tite ; it may be increased, diminished, or perverted ; there being at times a 
strong craving for particular kinds of food, at other times an aversion to 
all nourishment. An uncomfortable sense of weight, burning, or pain in 
the region of the stomach after taking food, flatulence, heartburn, con- 
stipation or diarrhoea, lassitude, a dull feeling in the head, depression of 

271 



_,- DISEASES OF THE STOMACH AND INTESTINES. 

spirits, an J irritability of temper, are all symptoms which usually accom- 
pany dyspepsia. Certain cases are characterized by the return into the 
month of small portions of the contents of the stomach. As patients 
describe the process, "they taste their food after eating it." The liquid 
raised is sometimes intensely sonr ; it may be acrid, appearing to scald the 
throat ; occasionally it is greasy, nauseating, and of extremely offensive 
taste and odor. Water-brash is the regurgitation into the mouth of a 
considerable quantity of liquid, which is thin and watery, insipid, saltish, 
or acid. This occurs usually in the morning, when the stomach is empty 
of food, and is at times preceded by a sense of constriction and more or 
less pain in the region of the stomach. In a certain class of cases of dys- 
pepsia, water-brash occurs as the chief symptom. 

Cardialgia, popularly known as heartburn, is a pain of a burning char- 
acter, which shoots from the upper part of the stomach into the chest and 
up into the throat. This is a common symptom in certain forms of indi- 
gestion, and is assumed to be dependent upon the presence of an acid in the 
stomach, as it is quickly and completely relieved for a time by an alkaline 
agent. There is generally present in dyspepsia a dull, usually insignificant 
pain in the region of the stomach, accompanied by a feeling of weight and 
fulness in the abdomen. In the majority of cases there is an accumulation 
of gas either in the stomach or intestines, generated by the putrefactive or 
fermentive changes in the food which they contain. While abdominal 
distention due to this cause does not exist in all cases of indigestion, in 
many it is a prominent symptom. If the accumulation is considerable, the 
distention is painful ; it embarrasses respiration, and by pressure against 
the heart disturbs the action of that important organ. It is not uncom- 
mon for dyspeptics to complain of palpitation and shortness of breath on 
slight exertion, leading many to suppose that they are suffering from heart 
disease. Other nervous disturbances not infrequently assume a marked 
prominence ; vertigo, sleeplessness, lassitude, and pains in the limbs, are 
symptoms which accompany the affection. 

Under the influence of dyspepsia the mind becomes noticeably dis- 
ordered; it is less active during the processes of digestion, and patients 
find it difficult to concentrate their attention upon any subject. Chambers 
graphically describes the mental condition in many cases: " There is great 
languor and incapacity for exertion, coming on generally about an hour 
after food, and accompanied in some cases by an almost irresistible drowsi- 
ness, which lasts for several hours. This symptom is particularly marked 
in the afternoon, if the patients dine in the middle of the day and 
endeavor to continue their employment afterward. Yielding to the 
drowsiness and taking a siesta seem to make matters worse, for there is 
usually felt after such an indulgence an intense headache or giddiness, 
which continues longer than the symptoms would have done had the 
inclination to sleep been resisted. The depression of spirits is not so 



DYSPEPSIA. 273 

remarkable as the feeling of utter helplessness, both of mind and body, 
accompanied in persons naturally active with a sense of shame at their 
unwonted apathy." 

Dyspeptics generally suffer more or less from mental depression. They 
lose their buoyancy of spirit, and become dejected, irritable, and disposed 
to look always upon the dark side. Often the rich man is possessed 
with gloomy forebodings of approaching poverty ; the workman sees 
visions of the almshouse pass before his eyes, while his actual situation is 
in every respect comfortable and well assured. Patients suffering from 
severe and persistent dyspepsia are apprehensive of the existence of some 
grave disease ; some obstinately maintain that they have consumption or 
heart disease. Occasionally this mental disorder develops into melan- 
cholia and hypochondriasis. 

In addition to the symptoms already described, many others are pre- 
sented during the prolonged course of dyspepsia. Constipation usually 
exists, generally alternating with diarrhoea. There is a perversion of taste, 
thirst, frequently a coated tongue, and foul breath. The vigor and nutri- 
tion of some patients are not materially altered by this affection ; in others 
the impairment is noticeable, and they present a prematurely aged appear- 
ance. The skin becomes sallow, dry and rough, and the extremities, often 
cold, show deficient activity of the circulation. Persistent dyspepsia tends 
to eventuate in chronic gastric catarrh, which is very tedious in its course, 
and may persist for years. This disease, if developed, will not in itself 
prove fatal, but may, however, by impairing nutrition, bring about enfee- 
blement of the system, and so indirectly shorten life. 

An indefinite number of agencies are capable of causing the disease under 
consideration ; some by affecting the digestive processes directly, others by 
doing so indirectly. Loom is says : " Improper diet is a common cause of dys- 
pepsia. It may arise from an excess of starchy materials, as potatoes ; or from 
deficiency of meats. Under improper diet may be included decomposing 
food, impure water, badly cooked food, too rapid eating, the food not being 
sufficiently masticated, or taken at too short intervals and irregularly. 
Articles of food that may be suited to one climate, season, or age, may, in 
another, be wholly indigestible and cause dyspepsia." There are also 
many irritants in common use, such as drugs, hot spices, and the like, which 
injuriously affect the digestive processes, and directly induce the affection. 
The habitual excessive use of alcoholic liquors, particularly the concen- 
trated forms, engenders dyspepsia. 

The indirect are in the majority of cases the agencies which are 
involved in the causation. Dyspepsia is often inherited, and it accom- 
panies the changes of advancing age. It occurs as a consequence of dis- 
ordered states of the blood and enfeebled conditions, such as result from a 
variety of excesses, among them the use of narcotics, tea, and tobacco. 
One of the most potent causes of this disease is deficient physical exer- 



274 DISEASES OF THE STOMACH AND INTESTINES. 

eise : laborers are proverbially exempt from digestive disturbances. On 
the other hand, walking after a full meal favors the occurrence of indiges- 
tion ; letter-carriers frequently suffer from the complaint. As one able 
authority states, "In a large proportion of cases, dyspepsia originates and 
is perpetuated by mental causes. It is induced and kept tip by anxiety and 
depression. Disorder is often, in the first place, produced by mental 
causes, and then re-acts upon the mind, increasing its morbid condition. 
An examination into the previous history of cases will frequently show the 
affection to have been preceded by mental inquietude of some sort. Per- 
sons of a certain mental constitution are especially prone to dyspepsia, 
namely, those so constituted as to be constantly anxious about something, 
such as acquiring success in life, getting out of debt, securing an indepen- 
dent position, or about imaginary troubles. The period of life when per- 
sons are most prone to dyspepsia is that in which anxieties are apt to be 
greatest, namely, between adult age and middle life. After the latter 
period, the events of life are taken more calmly, and there are fewer 
sources of intense anxiety. Persons who have been dyspeptics for many 
years are often free from this affection after having entered upon middle 
life. It may be doubted if the affection be often produced by overtasking 
of the intellect. When it occurs in those who are devoted to intellectual 
pursuits, it arises generally from the sedentary habits connected with these 
pursuits, or from mental anxiety; on the other hand, deficient exercise of 
the intellectual and moral faculties is apt to lead to it. Conditions in life 
involving ennui and dissatisfaction predispose to it." 

Treatment. While in many instances dyspepsia proves an extremely 
obstinate affection, rarely is recovery from it impossible ; much will, how- 
ever, depend upon the will of the patient. The first step in the treatment 
is to remove or obviate the cause, as far as this is practicable. As regards 
the diet of dyspeptics, individual experience will decide in any given case 
the particular articles of food to be indulged in. While at first it may be 
necessary to practice self-denial, and restrict the diet to substances easy of 
digestion, prolonged limitation is not advised ; but, as improvement takes 
place, attempts should be made to digest all the varied forms of whole- 
some food which the appetite craves. Regularity in eating is of no little 
importance, and the intervals between the meals should not be long, as long- 
fasting tends to weaken the powers of digestion. All the laws of health 
must be carefully observed, and of especial importance is sufficient exercise 
in the open air. Sir James Johnson once said that no case of purely func- 
tional dyspepsia could resist a pedestrian tour over the Alps. 

The influence of the mind over digestion must not be forgotten. As 
Chambers says, "Bread eaten in sorrow remains unabsorbed, and it is not 
without reason that, even in the earliest times, and among the most bar- 
barous tribes, companionship during meals has always been sought. It is 
not only painful reflections which disturb the digestion ; any concentrated 



DYSPEPSIA. 2' 



i 



thought is equally injurious, and injurious in a close proportion to the 
intellectual powers of the individual. The only people fit to feed alone 
are those fluttering butterflies whose intellects do not dispose them to 
concentrate their thoughts, and whose good luck exempts them from the 
need of trying. And even these instinctively seek society. To the brain- 
worker and the body-worker cheerful distraction at meal-times is a rule of 
imperious necessity, the habitual neglect of which entails chronic disease 
and the early failure of vital powers as a certain punishment." 

The prominence of individual symptoms must largely influence the 
selection of the medicinal remedies to be employed in the treatment of 
dyspepsia. Excessively acid risings, and the heartburn connected there- 
with, call for the use of alkalies, such as lime-water, bicarbonate of soda, 
or magnesia, after meals. These must not be taken in too large doses, or 
for a prolonged period, as the advantage gained by their use is only transi- 
tory, and in certain conditions they are capaple of doing more harm than 
good. Slight pain and dull sensation of pressure seldom demand especial 
treatment. When the stomach is very irritable, and vomiting is easily 
excited, the subnitrate of bismuth is a valuable remedy, and should be 
given in twenty-grain doses, before eating. If constipation exists, and 
there is much gaseous distention, the following is an efficient preparation 
in many cases : — 

J^ Sodge bicarb 

Pulv. rliei 

Saccb. pepsini .......... 

Pulv. zingiberis . 

Bismutb. subnitratis 

Pulv. cubebre aa 3 hj. 

Ft. pulv. Sig. : Dose, from one-third to one-balf a teaspoonful, after eating, in 
milk. 

If, after using this medicine for a time, the distention is not j^erma- 
nently relieved, and there is an odor to the breath, an offensive taste in 
the morning, and other so-called "bilious" symptoms, the following should 
be substituted : — 

J^ Mass. hydrarg gr. xvj. 

Pulv. ipecac gr. iv. 

Ext. taraxaci 3 ij. 

Ft. pil. No. 24. Sig. : Dose, one, tbree times daily, one-half hour before eating. 
(In making the pills, the druggist must first dry well his extract, and use a small 
quantity of powdered licorice.) 

After these pills have been taken for six da} r s, they should be discon- 
tinued, and the elixir of calisaya bark, iron, and strychnia be employed for 
several weeks. The dose at first should be one teaspoonful, and gradually 
increased to two teaspoonfuls, three times daily, before eating. While this 
tonic is being used, if gastric disturbances still exist, one or two peptonic 



276 DISK ASKS OF THE STOMACH AND INTESTINES. 

pills, or ten grains of the saccharated pepsine, taken after meals, will assist 
the digestive process. To remove constipation, fruits freely eaten, and the 
alkaline mineral waters, such as Vichy, Star, Hawthorne, etc., will usually 
he sufficient. 

In certain cases of dyspepsia, pain is a very prominent symptom, and, for 
a time at least, demands especial treatment; in such, the following prepara- 
tion will prove valuable: — 

J£ Acid, sulph. aromatici 3 ij. 

Liq. opii sed. (deod.) 3 ij. 

Tr. cardamom cornp 3 vj. 

Spts. chloroformi 3 ij ss. 

Aq. cinnamon ad. 5 iij. 

Ft. mist. Sig. : Dose, one or two teaspoonfuls. in water, one-half an hour before 
meals, and at bedtime. 

Even after the dyspeptic symptoms have disappeared, to obviate the 
danger of a recurrence, it will be necessary to persist in the use of tonics 
until the general health is restored. If anaemia be associated, the citrate 
of iron and quinia, in ten-grain doses, three times daily, after eating, is an 
excellent tonic. The tincture of the chloride of iron, in twenty-drop 
doses, is also an efficient preparation. The elixir of calisaya bark, iron, and 
strychnia, previously advised, is most serviceable in dyspepsia, and admir- 
ably suited to cases complicated with general debility. It should be 
persisted in for five or six weeks, and then the syrup of the hypophos- 
phites, or some similar preparation, may properly be substituted. Thus, 
tonics which renew functional activity and invigorate the vital powers 
should be alternated, until their use is no longer indicated. 



CHAPTER II. 

DIARRHCEA. 

The term diarrhoea is used to denote a morbid looseness of the bowels, 
the discharges being frequent, fluid or semi-fluid, and often otherwise 
altered in character. It is a symptom of a variety of affections ; it may 
result from intestinal inflammation, or appear as a functional disturbance, 
and it may be either transient or chronic. Diarrhoea is one of the most 
common ailments, and, while in many instances it can be quickly con- 
trolled, it is sometimes obstinate, and requires for its successful treatment 
measures which are in accordance with its causation. 

Fothergill says: "Diarrhoea maybe a salutary process, or an ailment 
serious enough to endanger life. Even when commencing as the first, it 
may eventually be fatal. The bowel is not only the means by which absorp- 
tion of our food goes on, but it is also a means of getting rid of excrc- 
mentitious material. Moreover, when a mass of objectionable or indi- 
gestible food is consumed, diarrhoea is the natural means of getting rid of 
it. Such diarrhoea is very common among children, and is often preceded 
or accompanied by emesis (vomiting). In the same way, bilious diarrhoea 
is a natural means of removing superfluous bile. Here diarrhoea is decidedly 
a salutary and not a morbid process." 

The so-called irritative diarrhoea, attended by pain and griping, is 
usually associated with indigestion, induced by dietetic errors; over-eating, 
food difficult of digestion, insufficient mastication, tainted meats, foul 
drinking-water, etc., are among the many exciting agencies. This form of 
the affection occurs most frequently during the summer season, explained, 
in part, by the larger proportion of fruit and vegetables then eaten, and 
by the effect of heat in weakening digestion. Over-exertion, unwonted 
irregularity in habits, worms, derangements of the liver, and the use of 
too powerful cathartics, are also to be included among the causes of 
irritative diarrhoea. 

Diarrhoea is frequently the consequence of a chill, especially in those 
persons in whom the intestinal canal is easily deranged. It also occurs 
when digestion is arrested by strong mental emotions, such as fright, grief, 
great anxiety, and severe pain. This form of the affection is called 

277 



278 DISEASES OF THE STOMACH AND INTESTINES. 

nervous diarrhoea, and, as has also been said, in persons so attacked it takes 
the place oi palpitation experienced by others when under mental agita- 
tion. In consumption, cancer, Blight's disease, and in many other chronic 
affections, diarrhoea occurs as a complication; it also often attends typhoid, 
malarial, and septic fevers. A prominent symptom in cholera morbus is 
diarrhoea, and the so-called choleraic form precedes an attack of cholera. 

Different remedial measures are demanded in the treatment of the 
varied forms of diarrhoea, and in their selection it is necessary to consider 
the causes and attendant symptoms. Frequently it is not advisable to 
check it, as it is a natural effort to carry off irritating matter from the 
intestinal canal. Indeed, it is often better to assist this effort, by gentle 
laxatives and judicious diet. If an attack is due to errors of diet, the first 
indication is to remove the substances which are causing the intestinal irri- 
tation, by a full dose of castor-oil, rhubarb, or a saline purgative, such as 
magnesia or Rochelle salts. If a cathartic is not employed in the early 
stage, and the discharges have been abundant, possibly a cathartic will not 
be needed. Dr. William Aitkin, of Edinburgh, says that one general rule 
may be acted on in the cure of diarrhoea, which is that in the adult, what- 
ever be the form of the affection, if the stools be dark at first and then 
become light-colored, purgative medicines are no longer beneficial, and in 
no instance ought they to be continued longer than is sufficient to remove 
any irritative substance accumulated in the intestinal canal. In all doubt- 
ful cases, one purgative dose at least should be given, to insure that the 
irritating contents have been expelled. 

If, after the bowels have been freely evacuated, diarrhoea, pain, or 
uneasiness continues, an anodyne may be employed. Often a teaspoonful 
of paregoric will effectually quiet the irritation ; Dover's powder, in five- 
grain doses, is also an admirable agent. In cases of great severity, one- 
grain doses of opium, or one-eighth of a grain of morphia, maybe needed. 
The remedy chosen should be repeated after six or eight hours, if required. 
Frequently under this treatment the bowels after a time become consti- 
pated, and a laxative will be indicated ; if a seidlitz powder does not suf- 
fice, a dose of castor-oil can be given. In occasional cases, there is a 
persistent looseness of the bowels, which does not yield to opiates, and 
astringents are demanded. In such cases, if the discharges are preceded 
by griping pains, it will be well to give the following : — 

J£ Tinct. kino 5 ss. 

Tinct. opii 3 ij. 

Syr. simp 5 ss. 

Chloroform i 3 j. 

Aquae menth. pip ^ ij ss. 

Ft. mist. Sig. : Dose, one teaspoonful, from four to six hours, as indicated. 



DIAR11HCEA. 279 

In cases where there exists persistent irritability of the bowels, and 

gastric symptoms, thirst and fever, are associated, the best results are 
obtained from the following: — ■ 

ty Tr. opii (deod.) 3 ij. 

Bismuth, subnit 3 iv. 

Syr. rhei arom 

Mist, Cretoe aa ^ ij- 

Ft. mist. Sig. : Shake. Dose, one teaspoonful, every three hours. 

When cases of diarrhoea in which the tongue is clean do not yield to 
opiates, or the astringent or the bismuth preparations, then five or ten grain 
doses of salicin, every four or six hours, will prove an excellent remedy to 
tone up the intestine. 

A correct diet is one of the most important elements in the treatment 
of diarrhoea; it is even of greater consequence than drugs. Milk alone, or, 
better, diluted with about one-third part of lime-water, given in small 
quantities and at frequent intervals, — a wine-glassful every second or third 
hour, and in some cases more frequently, — will generally be found to 
answer well, and may be continued for a time, to the exclusion of all other 
food. If a more generous diet is demanded to sustain the patient, beef- 
tea, raw beef juice or plain animal-broth, a raw egg beaten up with milk, to 
which a teaspoonful of brandy may be added, will usually be tolerated. 
Arrowroot, tapioca, or other plain farinaceous foods, are usually well borne. 
In cases of persistent diarrhoea, regularity in the times of administration 
and in the quantity of nourishment given is most essential. The greatest 
care should be taken not to give too much of anything at a time, and at 
once to discontinue whatever appears to occasion discomfort. 

It is necessary that the patient be kept warm, and rest in bed should be 
enjoined. In the treatment of chronic diarrhoea, the bismuth mixture 
advised above is the most reliable. As the discharges lessen in frequency, 
it will be well to omit the tincture of opium in its preparation. If, how- 
ever, the affection does not yield to this remedy, then the following should 
be tried : — 

^ Pulv. opii gr. vj. 

Ext. nucis vomicae gr. iij. 

Cupri sulphatis gr. j. 

Ft. pil. No. 12. Sig. : One, three times daily. 

A sea-voyage, a visit or removal from the city to the country, or the 
change of a warm, variable, moist, relaxing climate for an atmosphere cool, 
uniform, dry, and bracing, will be likely to prove highly beneficial. Above 
all else in importance, the diet, in quantity and quality, should be adapted 
to the digestive powers. 



DISEASES OF THE STOMACH AND INTESTINES. 



CONSTIPATION. 

The term constipation is popularly used synonymously with costiveness; 
the latter, however, merely means scanty discharges from the bowels, the 
number being normal, while the former is expressive of insufficiency both 
in number and quantity. Constipation is a troublesome malady, and one of 
the most common. When present, all the functions of life are more or less 
disturbed, and languidly performed ; it gives rise to a variety of symp- 
toms, both general and local. 

If a person accustomed to daily movements of the bowels passes two or 
three days without experiencing them, he complains of a feeling of weight 
ami pressure in the lower bowel, and a sense of abdominal distention or 
uneasiness, with flatulence. Digestion is impaired, there is a pain in the 
head, vertigo, loss of appetite, an offensive breath, and other symptoms of 
gastric and intestinal derangement. The brain is sluggish, the mind 
disturbed and inactive: sleep is broken and unrefreshing. Constipation 
also gives rise to palpitation, frequent flushings of the face, and, in some 
instances, to skin-eruptions. Often the eyes are surrounded with purplish 
rings, and the skin becomes dry and sallow. The tongue is usually relaxed, 
soft, and not infrequently indented with the teeth. 

The causes of habitual constipation are manifold : it has been called a 

rder of civilized society, being almost unknown among savages. It is 
relatively frequent among people of indoor, sedentary habits, as contrasted 
with those who are constantly occupied with outdoor employments. 
Deficiency of muscular exercise, severe mental application, anxiety, and 
inattention to the calls of nature, are recognized factors of causation. The 
affection is common in melancholia and insanity, and may occur in hysteria. 
Constipation results if the quantity of fluids taken into the stomach is 
insufficient to compensate for the amount of water excreted through the 
skin, lungs, or the kidneys. A change in habits of life or diet is fre- 
quently followed by a temporary attack of the affection. The prolonged 
use of food, such as milk, which furnishes but little residue, sometimes 
causes not only scanty but also infrequent evacuations. Among other 
causes capable of producing constipation are continued indulgence in an 
unvaried diet, the habitual use of coarse vegetable food, and the abuse of 
laxatives. There are many other medicines which induce the affection, 
among them opium. 

Constipation occurs as a complication in a variety of diseases ; it is 
common in chronic alcoholismus, organic and functional disturbances of 
the liver, ansemia, heart disease, certain affections of the lungs, and nearly 
all other maladies accompanied by emaciation. As joy, fear, or great 
fright sometimes excites diarrhoea, so do conditions of great mental depres- 
sion notably reduce the activity of the intestine. Habitual constipation 
not infrequently is the result of hypochondria; on the other hand, the 



CONSTIPATION. 281 

former disorder is sometimes the starting-point of a mental derangement 
which goes on to grave forms of the latter. Constipation of long standing 
may cause changes, which, after a time, become an additional cause, such 
as dilatation of the intestine and hypertrophy of its walls. The bowel, 
frequently distended, is weakened, and loses its contractile power; there 
is also more or less paralysis, and loss of that peculiar sensibility which in 
health occasions the desire to evacuate the fecal accumulation. 

Habitual constipation may properly be regarded as a disorder of the 
whole system, and not of the intestinal canal alone. In the treatment of 
this affection, many patients depend entirely upon the use of purgatives 
and laxative drugs, neglecting the more important hygienic measures, 
without which rarely can complete recovery be effected. . Much can often 
be done to overcome constipation by the free use of articles of food, such 
as cabbage, lettuce, and the various vegetables known as greens ; also 
fruits, especially dates, prunes, and figs, and the coarser grains, cracked 
wheat, corn meal, etc., articles with indigestible constituents, which stimu- 
late or irritate the alimentary canal. A diet consisting, or made up 
in part, of the articles mentioned will materially assist in the cure 
in all cases, and sometimes entirely overcome habitual constipation. 
Physical exercise undoubtedly promotes intestinal activity ; the same 
may be said of the external application to the body of cold water, cold 
sponge-bathing, and even, in some persons, drinking freely cold water has 
often the same result. Exhaustion and depression of vital forces, the 
causal agency of which is well recognized, may be counteracted by rest, 
change of scene, and a suitable regulation of diet. 

The most important part of the management in cases of habitual 
constipation is not embraced in the foregoing measures. It is the adop- 
tion of a rule to solicit an evacuation at the same hour daily. " The 
importance of this rule is to be enjoined, but, of course, its success 
will depend upon the perseverance of the patient. The time of day most 
convenient for the act of defecation is to be selected, and, in general, the 
most favorable time is in the morning, after breakfast. At the time fixed 
upon, the patient should devote a reasonable period to the function of defe- 
cation, but without persisting in violent, fruitless efforts. This should be 
considered in the light of a duty, not to be omitted a single day, except 
from necessity. It may be long before the desired object is accomplished ; 
but, sooner or later, with the aid of some of the means which have been 
indicated, the desire will be felt at the appointed hour, and the ability to 
defecate at that time will be acquired, in the great majority of cases. It 
is impossible to secure regularity and sufficiency of the evacuations with- 
out perseverance in this part of the management. The management also 
includes a rule not less important, namely, never to neglect or postpone 
the call to defecate, when it occurs, either after or before the time for the 
habitual performance of the act of defecation." 



Zb% DISEASES OF THE STOMACH AND INTESTINES. 

Doubtless some cases of habitual constipation would be obviated were 
fluids more freely taken. Women generally drink less water than their 
system requires for the proper performance of its functions. A glass of 
water, either cold or hot, before retiring and on rising, will not infrequently 
prove efficacious; greater action is secured by the addition of a table- 
spoonful of table-salt. Among the domestic remedies commonly employed, 
a mixture of prunes and senna is quite popular. A tea is made of the 
latter, and, after the leaves are removed by straining, prunes are cooked 
in the liquid, molasses being freely added. This constitutes a palatable 
dish, having very decided laxative properties. Injections of cold water, 
soap and water, etc., are at first efficient in promoting evacuations, but the 
lower bowel soon becomes accustomed to them, and its sensibility is 
lessened. 

Unfortunately, reliance on hygienic means alone for the cure of consti- 
pation is, in some cases, disappointing, and medicinal measures will be 
needed. Often patients suffering from habitual constipation try remedy 
after remedy, all failing to permanently benefit them. When one laxative 
has been used long enough to lose its effect, the intestines ceasing to 
respond to its stimulant influence, another is sought, which, at first more 
successful, eventually, in turn, ceases to act, except in excessive doses. Of 
all the old remedies, rhubarb doubtless has been the most popular of anti- 
costive medicaments. As one author rightly states, " Of all agents to be 
selected for an habitual purgative, this is the worst. If once resorted to, 
its use is necessitated, in consequence of its secondary action, which is to 
cause constipation." As an occasional laxative, a three-grain pill of aloes 
and myrrh, at bedtime, proves efficacious. In attempting to overcome the 
constipated habit, it is important to remember that purgation should be 
avoided. To secure a permanent benefit from the use of laxatives, it is far 
better to take them in small doses, repeated several times a day, rather 
than one single large dose. The following combination of iron, aloes, and 
rhubarb has proved of permanent benefit in many cases : — 

J^ Ferri sulph gr. xx. 

Pulv. aloes 

Pulv. rbei aa gr. xxx. 

Ft. pil. No. 30. Sig. : Dose, one. 

One pill should be taken three times daily, after meals, until two evacu- 
ations are caused each day ; then the morning dose may be omitted. Two 
pills will in turn prove too active, and the number may be reduced to one 
daily. Thus the gain is progressive, and recovery can be expected, if 
the patient will persevere, and employ at the same time proper hygienic 
measures. 

Among the new remedies, cascara sagrada seems growing in credit and 
favor; many cases have been reported in which this agent gave most grati- 



CONSTIPATION. 283 

fying results. If its use is long continued, it is likely to do less harm than 
other cathartic medicaments, as it is tonic as well as aperient, and causes 
neither griping nor nausea and diarrhoea. It may either be taken alone, or 
in combination as follows : — 

1^ Aloin gr. xij. . 

Ext. belladon. . . , gr. vij ss. 

Strychnia gr. j. 

Ext. cascarae sag gr. xxx. 

Ft. pil. No. 60. Sig. : Dose, one pill, two or three times daily, if needed. 

Before leaving this subject, a word to the teachers of public schools, 
who too often ignore the actual wants of the pupils in their charge. Not 
infrequently habitual constipation has its origin in youthful subjects, and 
becomes established because the promptings of nature are too often con- 
strued as childish caprice, and the function of defecation is ignored by 
enforced restraint. 



CHAPTER III. 
INTESTINAL COLIC. 

The term intestinal colic is applied to an abdominal pain more or less 
severe in character, aggravated at intervals, and occurring independently 
of structural changes. It is, therefore, a purely functional or nervous 
affection, and is attended by irregular, spasmodic contractions of the mus- 
cular coat of the intestines. In this disorder, the nerves supplying the 
parts involved are either subjected to unusual irritations, or they are them- 
selves in an altered condition, and abnormally sensitive. There are several 
varieties of intestinal colic ; the more common are flatulent, bilious, lead, 
and copper. 

Numerous conditions give rise to this affection, which is usually classi- 
fied under two heads, the first including the colics which are occasioned by 
abnormal irritants in the intestinal canal, and the other those which are due 
to an abnormal irritability of the intestinal nerves. To the first class belong 
the painful attacks excited by worms, foreign bodies, kernels of fruit, par- 
ticular kinds of food, — such as mushrooms, shell-fish, etc., — fecal accumu- 
lations, and gall-stones of large size. Constipation may act as an indirect 
cause of colic, by retention of gases. The so-called flatulent variety, or 
" wind-colic," is often preceded by the use of tainted or fermentable arti- 
cles of food, such as cabbage, or certain other vegetables, new beer, etc. 
It is sometimes produced by wholesome food, when taken too cold, in 
excessive quantities, or if it is coarse and difficult of digestion. AVI 1 en the 
digestive processes are by any influence retarded, gas is generated by 
decomposing changes, and thus, by distention of the bowels, the intestinal 
nerves are irritated, and pain is the consequence. Attacks of colic occa- 
sionally follow exposure to cold ; many cathartics are also capable of induc- 
ing them. 

While the irritation of the intestinal nerves by which colic is produced 
usually starts in the intestinal wall, in some cases it proceeds from the 
centrally situated portions of the nerves. Thus, in certain diseases of the 
liver, kidneys, uterus, ovaries, and spinal cord, colics sometimes occur 
which admit of no other explanation. The metallic poisons, lead and 
copper, act first on the general nervous system, and colics are then pro- 

2S-t 



INTESTINAL COLIC. 285 

duced as a secondary consequence. There are conditions, such as hysteria, 
characterized by perverse irritability of the entire nervous system, which 
may give rise to intestinal colic attacks; they also proceed from impaired 
nutrition of the nerves. The term bilious colic has been used when the 
affection is supposed to depend upon liver derangements. Gout and rheu- 
matism favor attacks. While in many cases the cause is apparent, in a 
certain number it eludes detection. 

An attack of colic may be preceded by slight nausea and belching of 
wind, a sense of distention in the abdomen, rumbling, languor, irritability 
of temper, or apathy, and slight intermittent pains, or it may develop at 
once in its full intensity without any warning. The pains are of a tearing, 
cutting, and most frequently of a griping character, and although they 
may shoot in various directions, they are usually situated in the region of 
the navel. The patient is generally restless, and, in extremely severe 
attacks, he bends his body forward, with knees drawn up, or rolls about in 
pain, trying a variety of positions, and attempts to relieve his distress by 
pressing his hands, or some hard substance, against the abdomen, or by 
lying on his stomach. Anxiety and an expression of intense suffering are 
depicted upon his face ; he groans or cries aloud, despairing of relief. The 
extremities are chilled, and the skin is covered with a cold sweat ; the pulse 
is usually small, hard, and, at least in lead-colic, is slow. Generally there 
is an absence of tenderness ; and firm pressure with the hands, or lying on 
the face, affords relief; occasionally, however, the abdomen is more or less 
tender and painful on pressure. The appearance of the abdomen varies in 
different cases ; the coverings are tightly drawn and rigid, sometimes 
retracted, at other times distended. The abdominal muscles share in the 
spasm during the paroxysms of pain, as shown by their tension ; sometimes 
sections of them can be felt as hard bunches. Constipation is generally 
present in this affection ; frequently there are vomiting, hiccough, and pal- 
pitation. 

The duration of colic is extremely variable ; it may last a few moments 
only, or for days with intervening remissions. If left to continue without 
measures of relief, not infrequently the affection terminates with a move- 
ment of the bowels, or an escape of gas in an upward or downward 
direction. In some cases the disappearance of the pain is sudden and 
complete, in others milder paroxysms mark the cessation of the attack. 
While intestinal colic, constituting an individual malady, is independent of 
inflammation or structural changes, colic pains are symptoms of different 
inflammatory affections — namely, dysentery, enteritis, peritonitis, and the 
functional disorder cholera morbus. 

In flatulent colic, often called crapidous when it proceeds from indiges- 
tion, the tongue is usually covered with a white fur, or it is bright red at 
the tip and edge. With this form are sometimes associated pains in the 
head, giddiness, and dimness of sight. Bilious colic is preceded by loss of 



286 DISEASES OF THE STOMACH AND INTESTINES. 

appetite, nausea, and a coated tongue. Vomiting is present, and the 
matters raised are greenish and yellow. This form is sometimes ushered 
in by a chill : the bowels are obstinately constipated, and there is usually 
slight fever. Jaundice occasionally appears during the course of pro- 
longed attacks. Lead-colic usually comes on gradually, and increases in 
severity until intense paroxysms of pain follow each other in rapid succes- 
sion. The pain frequently shoots into the back and in other directions ; 
it is sometimes sharp and cutting in character, and at other times dull and 
grinding. The abdomen is usually contracted, depressed, and rigid; it is 
rarely tender, and firm pressure is generally well borne. In this form of 
colic, cramps, and pains in the extremities, occasionally occur. The bowels 
are constipated ; there is more or less nausea, and, not infrequently, vomit- 
ing; there is a peculiar fetor to the breath, and a metallic taste in the 
mouth. Hiccouo-h and belching of wind are not uncommon. The urine 
is scanty, and micturition is sometimes difficult and painful. The indi- 
vidual suffering from lead-poisoning is anaemic, sallow, and debilitated ; 
generally there is more or less emaciation. A bluish-gray line appears 
upon the gums; there is often paralysis of certain muscles of the fore- 
arm, and the sight may be markedly affected. Copper-colic is distin- 
guished from lead-colic by the fact that the pain is increased by pressure, 
the abdomen is distended more frequently than retracted, and in place of 
obstinate constipation there is diarrhoea, with greenish stools. A purplish 
line about the gums is noted ; and, in some cases, there is difficulty in 
breathing, from spasm of the larger air-passages. 

It is by no means easy, in all cases, to distinguish between purely 
functional colic and the pains which proceed from inflammatory or ulcera- 
tive diseases in the intestine. Although there are occasional exceptions to 
this rule, still, in a general way, it may be said that, when the pain is 
increased by deep pressure, inflammation rather than simple functional 
colic is indicated, while if the attacks of pain occur suddenly in good 
health, and without treatment there follows entire relief, then the disturb- 
ance is purely functional. If uncomfortable sensations in the stomach, 
with vomiting, precede or attend the beginning of an attack, it is presump- 
tive evidence that the colic is produced by indigestible food. If it arises 
from an excessive accumulation of intestinal gases, the fact is indicated by 
distention of the abdomen, by the rumbling of the bowels, and the momen- 
tary improvement of the symptoms when flatus escapes. If colic is 
excited by the presence of worms in the intestinal canal, the antecedent 
history is of great importance in determining the special cause. There 
will previously have been experienced uncomfortable sensations in the 
abdomen, a craving for food, and a great variety of nervous derangements. 
The evidences of lead colic are sufficiently distinctive, and when the chief 
features of lead-poisoning are well marked, no difficulty will be expe- 
rienced in reaching a diagnosis. 



INTESTINAL COLIC. 287 

The first object of treatment is the relief of pain, and measures to 
attain this end are to be employed without reference to the cause of the 
attack, or the existence of constipation. Remedies to control the suffer- 
ings of the patient take precedence, and no attempt to overcome other 
symptoms should be made while the pain exists. In mild attacks, hot 
applications to the abdomen, and the internal administration of ginger, 
peppermint, or some alcoholic stimulant, diluted in hot water, will often 
suffice to procure relief. If not, opium in some form will be indicated, 
and should be given at intervals until the pain is controlled. If the 
stomach can retain medicine, the following preparation will prove effica- 
cious : — 

fj, Chloroformi 3 ss. 

Elixir McMunn's 3 j ss. 

Ext. pruni virg. fld ad. 5 lv - 

Ft. mist. Sig. : Shake well. Dose, one teaspoonful, in sweetened water, every 
half-hour, until pain ceases. 

If this mixture cannot be easily obtained, laudanum or paregoric, which 
are to be found in nearly every household, may be substituted. The dose 
of the former is twenty-five drops, of the latter two teaspoonfuls. If 
complete relief does not follow the administration of either of these forms 
of opium, within the space of one or two hours, the dose should be 
repeated. If in attacks of colic vomiting exists, then one-half a teaspoon- 
ful of laudanum in a little starch-water may be given by injection, and 
repeated, if needed, after an hour has elapsed. In event a physician is 
employed, he will, without doubt, administer a hypodermic injection of 
morphia, and by this means speedy relief will be obtained. Mustard 
poultices, hot fomentations, or dry heat, should be applied to the 
abdomen, as they contribute much to the success of the internal treatment 
advised. 

After the pain has been subdued, the causes which underlie the occur- 
rence of the colic should then be removed. In all cases cathartics are 
indicated, and the salines Rochelle salts, magnesia, etc., may be given ; or, 
if castor-oil is not offensive to the patient, its employment will be the most 
judicious. To relieve the constipation in lead-colic, Epsom salts are to be 
preferred, as, in that affection, a powerful purgative is usually demanded. 
In all cases where the diagnosis is doubtful, and there is a suspicion that 
intestinal stoppage or inflammation exists, then cathartics should be 
withheld, or given guardedly, in divided doses, repeated at intervals of 
one or two hours. Considering the fact that colic sometimes ceases sud- 
denly, caution is to be exercised in the repetition of opiates. This subject 
is discussed at considerable length in the chapter devoted to " Medicines 
and their Administration." 



288 DISEASES OF THE STOMACH AND INTESTINES. 



CHOLERA MORBUS. 

Cholera morbus, also called sporadic cholera, is a form of acute gastric 
catarrh, occurring with simultaneous inflammation of the intestine. As has 
been said, the severity of the accompanying symptoms, at times apparently 
threatening- life, resembles so closely those observed in Asiatic cholera, that 
it is impossible to distinguish one disease from the other, unless regard is 
had to the absence or prevalence of epidemic cholera at the time. 

Cholera morbus almost always occurs during midsummer and early 
autumn. A variety of causes are influential in its production, among them 
sudden checking of the perspiration, or suddenly chilling the surface of 
the body by external cold or acid drinks, and a rapid fall in the temperature 
during a heated term. If several intensely warm days are experienced, and 
there then suddenly follows damp, chilly weather, attacks of this affection 
are notably more frequent, and can be attributed to this radical change in 
the atmosphere. Cholera morbus is often caused by eating certain sub- 
stances, such as unripe fruits, cucumbers and other vegetables burdensome 
to the stomach. To indigestion alone the disorder seems to be attributable. 
It is generally accepted that the affection involves a specific cause, the 
nature and source of which are unknown ; possibly it may be some peculiar 
atmospheric condition. 

Notwithstanding the apparently threatening symptoms, cholera morbus, 
occurring in adults, rarely proves fatal. On the other hand, the same 
malady, which, when it attacks children, is called cholera infantum, is 
especially fatal in infancy. In the aged, and patients previously in 
delicate health, the prognosis is also less favorable. The duration of the 
affection varies from two hours to two days, and patients usually recover 
rapidly. 

An attack of cholera morbus is often abrupt ; in some cases it is pre- 
ceded for a short time, rarely longer than a few hours, by nausea, faintness, 
and possibly by colic pains and diarrhoea. The individual is usually 
attacked in the night, by a sense of oppression, or a feeling of uneasiness, 
in the pit of the stomach ; vomiting soon occurs, and it is speedily followed 
by purging. The matter thrown off from the stomach at first consists of 
food recently taken ; later it is watery and yellow, from the admixture of 
bile. The fluid is usually acid, and sometimes it is so acrid and bitter it 
occasions a burning sensation in the throat. At the same time there is 
almost continuous diarrhoea; one watery, slimy, odorless passage is rapidly 
succeeded by another, and they, in a like manner, scald the opening from 
which they are ejected. Evacuations from the bowels are preceded and 
accompanied by colic pains, often extremely severe, which are temporarily 
relieved by the discharge. Purging and vomiting either occur together, or 
rapidly succeed one another; the patient usually suffers from dryness of 
the mouth and throat, with insatiable thirst. The abdomen may be at first 



CHOLERA MORBUS. 289 



distended, but after a time becomes contracted ; tenderness is either slight 
or wanting. The abdominal muscles are sometimes knotted in hard 
bunches, as in intestinal colic. 

With the symptoms described in the foregoing, there are associated 
anxiety, restlessness, and exhaustion proportionate to the intensity and 
duration of the attack. There is more or less increase in the rapidity of 
the pulse, which is small and feeble. The skin is cool or cold, and covered 
with a profuse, clammy sweat. The countenance becomes shrunken and 
pallid, or livid ; the voice is feeble, and sometimes altered in quality. In 
all severe cases, there are cramps in the lower extremities, especially in the 
calves of the legs and feet, and, if the attack is protracted and runs a fatal 
course, unmistakable signs of general collapse are manifested, and the 
patient passes into the so-called algid stage, in which the surface is ice-cold, 
and from which there is little or no hope of recovery. Convalescence com- 
mences, or death usually occurs, in from twenty-four to forty-eight hours. 
A fatal issue in adults is exceedingly rare, yet the fact that such'a termina- 
tion is possible should always be borne in mind, and prompt and effective 
measures be applied in every case. The writer recalls, in his practice, three 
instances of death from this affection, all occurring within a few hours from 
the time of the attack. In a majority of cases of cholera morbus, after 
continuing for several hours, vomiting and purging become less severe, and 
the acts occur at longer intervals; the pains subside, and the general 
improvement is rapidly progressive. As one author says, "it is remark- 
able that an affection involving so much disorder should leave the 
affected organs in a condition to resume so speedily the exercise of their 
functions." 

In mild attacks of cholera morbus, often ice, given in small pieces, will 
check the vomiting, if fluids are withheld and mustard poultices applied to 
the pit of the stomach. In severer cases, the employment of opium in 
some form will be demanded. The following mixture of morphia, in com- 
bination with other agents, has proved effective: — 

J^ Morphise snlph gr. ij. 

Acid, carbolici gr. v. 

Sodse sulphatis 3 iij. 

Aq. cinnamon 5 ij« 

Ft. mist. Sig. : Dose, one teaspoonful. 

The first dose of this medicine will perhaps be immediately rejected ; if 
so, a second should at once be given. If a second or a third be instantly 
or quickly thrown off, then the administration by the mouth should be 
abandoned, and one-half a teaspoonful of laudanum, in a little rice- 
water, may be injected into the bowel. If this is not retained, then a 
physician must be summoned, and a hypodermic injection of morphia 
resorted to. 



200 DISEASES OF THE STOMACH AND INTESTINES. 

It is of the utmost importance in the treatment of cholera morbus that 
liquids be withheld. The raging thirst must be appeased with small pieces 
of ice, as to drink freely tends to prolong the affection. Mustard poultices 
should be applied to the abdomen, and warmth of the body maintained by 
sufficient clothing. If the extremities become chilled, they must be packed 
in blankets, and surrounded with bottles of hot water. If this fails to 
restore the natural heat, then without delay a hot bath should be given, 
and followed by hot packing. If there is great prostration, stimulants will 
be demanded, and. in very severe cases, their use must not be long delayed. 
Brand v may be added to the cracked ice, and a small quantity of the 
former given with the broken pieces of the latter. In all attacks of this 
affection, an entire deprivation of food is essential, until the vomiting is 
controlled. If, in any individual case, absolute fasting seems to be not 
altogether without danger, the patient's nourishment should be limited to 
iced milk and lime-water, in equal parts. Of this a teaspoonful may be 
allowed at intervals of a few minutes, but never in greater quantities, until 
the violence of the malady has abated. After the subsidence of the attack, 
care as regards diet is in most cases alone required. 

EPIDEMIC CHOLERA. 

Epidemic cholera is an affection entirely distinct from cholera morbus, 
although they have certain prominent symptoms in common. It has 
received a great variety of names, such as Indian, Oriental, and Asiatic 
cholera, malignant, pestilential, algid, or blue cholera, etc., etc. This dis- 
ease has been a common one in India, almost from time immemorial, but it 
is only since the great development of commerce and intercommunication 
between nations, of the present century, that it has prevailed outside of 
Asia. Several cholera epidemics have visited America: the first made its 
appearance in the year 1832; the last in 1873. At the present writing, it 
is predicted that the time is near at hand when another epidemic may 
reasonably be expected. 

In 1SS3. Dr. Koch, of Berlin, with certain associates, was sent to Egypt 
by the German government, to study epidemic cholera. On reaching 
Alexandria, where the commission pursued its studies, the disease was 
already declining, and only twelve cases could, therefore, be investigated 
during the progress of the malady, and ten were examined after death. 
The only distinctive result reached was the verification of the constant 
presence of a micro-organism of the bacillus type in the intestinal walls, 
which had previously been observed by Koch in specimens from cholera 
victims sent him from India, and which he had hitherto thought might be 
attributable to putrefactive changes. The commission, with the consent of 
the German government, afterwards proceeded to Bombay, to pursue 
its investigations under more favorable circumstances, and with ample 
material. 



EPIDEMIC CHOLERA. 291 

Returning after a time to Berlin, Dr. Koch made systematic experi- 
ments on the detection and cultivation of the "comma-bacillus," which he 
declared to be the proximate cause of Asiatic cholera. That micro- 
scopic creature itself is produced (such is the theory) in the Delta 
of the Ganges, where cholera seems to prevail as constantly as the 
small-pox does in Canada. Dr. Koch, the oldest investigator in this 
direction, is of this opinion. Formerly the disease was said to be indige- 
nous in Ceylon, Madras, and Bombay, but it is now known that it is due 
there entirely to the traffic between these places and the Delta. This entire 
tract is its unceasing home. The upper part is densely inhabited, while 
the lower part is unapproachable to man because of inundations and 
pernicious fevers, but is at the same time the home of a luxuriant vegeta- 
tion and abundant animal life. Quantities of animal and vegetable matter 
are there exposed to putrefaction, and Dr. Koch maintains that there is no 
place in the world so favorable for the development of micro-organisms of 
an infectious character, and that the inhabited parts of the Delta are also 
exceptionally favorable, wherever the refuse from a thickly populated 
country is floated down by small streams, and mixes with the brackish 
water of the Ganges, which flows backward and forward, already saturated 
with putrefied matter. There is much evidence that cholera derives its 
origin from this frontier territory, and all the greater epidemics have been 
accompanied by an increase of the disease in the south of Bengal. The 
entire country of Lower Bengal is only slightly raised above the sea-level, 
and during the rainy season almost submerged, the inhabitants being 
compelled to build their huts upon raised ground. This is effected by 
taking the earth near where the hut is built to raise the ground on which 
it stands, and the result is to leave a large tank adjoining each hut, in 
which soiled water and putrefied matter from the household collect. This 
very water is used for drinking and other household purposes, and in turn 
receives much of the refuse matter which is necessarily thrown out. 
Such a condition of things would breed pestilence anywhere, and here the 
"comma-bacillus" finds its seed-bed. 

It is still a question with many whether Dr. Koch's bacillus is in fact 
the germ of cholera. Dr. Sternberg, of the United States army, in his 
recently published edition of Dr. Maginn's work on "Bacteria," says, or 
makes his author say: "The difficulties connected with such an investiga- 
tion (as Koch's) are very great, for the reason that a multitude of harm- 
less micro-organisms are constantly present in the discharges from the 
bowels of healthy persons, and of cholera patients as well ; and because no 
one of the lower animals has as yet been proved susceptible to the 
disease." 

In regard to the relation of the "comma-bacillus" to cholera, the 
medical world is divided ; many believe that it is the cause of the disease 
in question; others deny that it stands in that relation. Each extreme 



292 DISEASES OF THE STOMACH AJSB INTESTINES. 

is, however, based on speculation, and judgment should be suspended 
until more light has been thrown upon the subject by further investiga- 
tion. 

There can be little or no doubt that a special cause is essential to the 
production of epidemic cholera. It is also an established fact that the 
"germ" of this disease is transportable in merchandise, in clothing, in 
bedding, in the persons of unclean people, and often in ways the most dif- 
ficult to trace. It is equally true that cholera never spreads to a dangerous 
extent, when once imported, except in filthy places. The method of inocu- 
lation is supposed to be by the mouth, not by the lungs or skin; and the 
more clearly jieople are thus defended by their cleanliness, contagion, in 
the strictest sense of the word, is but little more to be feared than with 
typhoid fever. 

In the majority of cases, one of the earliest symptoms of cholera is a 
simple diarrhoea, the discharges being frequent and painless. Occasionally 
vomiting and cramps precede the diarrhoea, and not infrequently there is 
experienced a feeling of weight in the region of the heart, rumbling of the 
bowels, and general disinclination to exertion, vertigo, ringing in the ears, 
and headache. The premonitory symptoms, when existing, usually con- 
tinue about two days. They may be, however, frequently absent, the dis- 
ease commencing precipitately, with a painless diarrhoea. In the majority 
of cases, the attack occurs during the night. If looseness of the bowels 
has existed, the discharges are suddenly increased in quantity, or sudden 
and copious liquid stools, without previous diarrhoea, mark the onset of the 
disease. These discharges sometimes, after the second evacuation, lose 
their natural odor and color, and become yellowish-white, or assume a 
whey-like appearance. They contain, in more or less abundance, small, 
white, solid particles, like grains of rice in rice-water. In some cases, the 
diarrhoea soon ceases ; in others, after a time, the evacuations are constant, 
and beyond the control of the patient. Vomiting usually occurs, and 
occasionally it is persistent, everything taken into the stomach being 
rejected. The tongue is dry, and covered with a thick, white coating; 
the patient is soon exhausted, and assumes a peculiar apathetic condition ; 
the countenance becomes pinched, and of a leaden hue: the expression is 
dull and staring. Immediately preceding the stage of collapse, the pulse 
becomes imperceptible at the wrist ; often there is distressing hiccough, 
and the breathing is more or less accelerated and frequent. 

When the collapse occurs, and the so-called algid stage is entered, there 
is a well marked fall of temperature; first the hands, feet, and face 
become icy cold, and soon the entire surface is similarly affected. The 
skin, which is wrinkled in hard folds, like the hands of a washerwoman, 
is of a bluish color, and is covered with a clammy sweat. Purplish rings 
form around the eyes, which seem to sink in their sockets, and the features 
are pinched and shrunken. In some cases, there are severe cramps, 






EPIDEMIC CHOLERA. 293 

chiefly in the calves of the legs, which recur from time to time, wringing 
shrieks from the unfortunate victim. As the end approaches, these grow 
more frequent ; the beating of the heart is imperceptible ; then with 
difficulty is heard the hoarse, sepulchral '-cholera whisper," — the choleraic 
picture is complete ! 

When cases of cholera end spontaneously, or are arrested before the 
stage of collapse is entered, the vomiting and purging cease, improvement 
as regards other symptoms follows, convalescence soon commences, and 
recovery is rapid. Usually the duration in these cases is a few hours 
only ; the proportion which pursue this course is small. Fatal cases 
usually terminate within two or three days, while the average duration of 
those in which recovery takes place is nine days. Of all attacked with 
cholera, generally one-half die. The rate of mortality varies much ; in the 
better classes it is lower than among the poorer people, subjected to un- 
favorable influences. The chances of arresting this disease are good, 
provided treatment is commenced immediately after the attack. If the 
malady advances to the stage of collapse, the prognosis is always exceed- 
ingly unfavorable. 

In the treatment of cholera, one writer says, "the inspiration of hope 
and confidence are primal necessities." The first symptoms of the disease 
must be quickly controlled. During an epidemic, remedies to arrest 
disturbances of the bowels should be kept in every home, and the slightest 
evidence of disorder must be the signal for their immediate use. When 
an attack occurs, "a hot bath for fifteen minutes, the quick envelopment 
of the entire body in dry, hot flannels immediately after the bath, the 
stimulation of the cutaneous surface with dry mustard and with friction 
under cover of the clothing, artificial heat, so applied as to secure, if possible, 
free perspiration, — these all conspire to divert the circulation and save 
from intestinal congestion." From that time the patient should be 
compelled to remain in the recumbent position. No solid food should be 
allowed under any circumstance. Acidulated drinks are pleasant, and in 
very small quantities beneficial. Opium in some form is the one remedy 
to be depended upon ; the following preparation has proved of service in 
the hands of physicians : — 

jj^, Morphise sulphatis gr. j. 

Tr. cardamon. comp 5 j« 

Tr. capsici 3 iij. 

Spts. camphorse 3 j. 

Ft. mist. Sig. : Dose, one teaspoonful. 

During an attack, a teaspoonful should be taken in a w T ine-glass oi 
water every fifteen minutes, until the discharges cease. After that its use 
should be persisted in at longer intervals, possibly from two to four hours, 
until the patient becomes drowsy. As a preventive remedy, this medi- 



294 DISEASES OF THE STOMACH AND INTESTINES. 

cine is serviceable for all forms of diarrhcea, occurring during the exist- 
ence of an epidemic of cholera. Unless there is reasonable evidence 
suppose that this disease has attacked the patient, one teaspoonful from 

two to three hours will ordinarily he sufficient. Although patients 
affected with cholera suffer insatiable and tormenting thirst, water should 
be denied them, and only pieces of ice be allowed. 






SECTION V. 
DISEASES OF THE ABDOMINAL OEGANS. 



CHAPTER I. 

ACUTE PERITONITIS. 



The peritoneum is a serous membrane which lines the abdominal 
cavity and covers the organs therein contained, occupying the same rela- 
tion with them as exists between the pleura and the lungs. It possesses a 
very great extent of surface, and constitutes the largest serous cavity in 
the body. This membrane is much less frequently the seat of inflamma- 
tion than is the case with others alike in character, as, for example, the 
pleura. The reasons why it should exhibit so varied a behavior are not 
yet understood ; they may depend upon minor differences in their struc- 
ture, or upon dissimilar influences in their local relations. Acute inflam- 
mation of this membrane, or acute peritonitis, by reason of its intimate 
connection, is herein considered with diseases of the abdominal organs. 

Symptoms. An attack in nearly all cases of acute peritonitis is abrupt, 
and the disease quickly declared. In certain forms of the affection, the 
first symptom is a pronounced chill; in all cases, the local and gradually 
increasing pain is one of the earliest manifestations. In severe cases, 
if local at first, it extends over the whole abdomen in a few hours. The 
character of the pain is not easily described ; it seems to combine the sen- 
sations of burning, boring, and cutting. Its intensity is increased by 
movements of the body, and even by the respiratory acts. As a rule, the 
more sudden the onset the more severe the pain, which is equalled in but 
few other diseases. It presents one prominent characteristic : the slightest 
pressure increases its intensity, and, in some cases, even the weight of the 
lightest bedclothing cannot be borne. By reason of the pain, also, the 
movements of the patient are guarded ; every change of position is stu- 
diously avoided, and he lies on his back, with the knees drawn up ; his 
arms alone are tossed to and fro, an evidence of restlessness and anguish. 
The number of respirations is increased three-fold, or even more ; they are 
short and shallow. Every attack of coughing is most anxiously sup- 
pressed, and when the irritation can be no longer overcome, the patient 



200 DISEASES OF THE ABDOMINAL ORGANS. 

coughs gently so as to avoid, as far as possible, any pressure on the 
abdomen. The bowels are usually constipated ; but occasionally diarrhoea 
exists in the beginning of the attack, or subsequently occurs. If the peri- 
tonitis is general, the abdomen becomes greatly distended and feels hard 
and tense. Vomiting is frequent, and in some cases a prominent symptom, 
adding greatly to the patient's suffering ; often distressing hiccough is at 
the same time present. The face is pallid, and wears a drawn, pinched, 
and anxious look ; the changes are in part due to the pain, and in part to 
the general collapse in which it participates. When the upper lip is ele- 
vated and drawn tightly over the teeth, the appearance is almost diag- 
nostic of the disease. 

The temperature is considerably raised, and the fever is of a remittent 
type. In fatal cases the former falls below the normal during the period 
of collapse. The pulse is accelerated from the first, and increases in fre- 
quency, becoming small, hard, and wiry in character, and hardly percep- 
tible at the wrist. The evacuation of urine frequently cannot be effected 
by natural means, owing to paralysis of certain important muscles. When 
instrumental interference is not demanded, the passage of water is accom- 
panied by pain, sometimes extremely intense. The intellect generally 
remains clear throughout the course of the affection, even to the 
final struggle. If delirium occurs, it is slight, and delayed until near 
the end. 

Causation. Acute peritonitis, exclusive of the form which occurs in 
childbed, is not a frequent disease. It may follow directly, or remotely, 
injuries of various kinds; accidental wounds of the abdominal walls, and 
violent contusions, are liable to induce it. It may be caused by surgical 
operations which involve the opening of the peritoneal cavity, in cases of 
ovariotomy, etc. Injections into the womb have been known to give rise 
to the disease. In the great majority of cases, peritonitis is dependent 
upon some affection of the abdominal organs. Among the exciting causes 
may be included obstructions, ulcerations, and perforations of the intes- 
tines, and abscesses of the abdominal walls and adjacent parts. Inflam- 
mations of other organs covered by the peritoneum, and those parts which 
surround or lie in contact with it, are liable to extend and involve this 
membrane. General peritonitis is, in many instances, the immediate result 
of infection ; in conditions characterized by blood-poisoning, it is most 
likely to occur. The affection is incidental to diseases of the kidneys ; it 
has also been traced to exposure to intense cold. 

Prognosis. The course of acute general peritonitis is usually a rapid 
one, and the disease may be considered as very fatal. Death Occurs in 
many instances within five or six days ; it may come in a few hours, or be 
delayed two or three w T eeks. The prognosis in any case is, to a great 
extent, determined by the cause which induces the attack ; it is most 
unfavorable when it results from perforation, obstruction of the intestine, 






ACUTE PERITONITIS. 297 

blood-poisoning, or complicates chronic diseases of the kidneys. It is most 
favorable when the peritonitis is due to extension of inflammation from 
some internal organ. 

The symptoms which indicate a change for the better, are a uniform 
decrease in the pain, tenderness, distention, rapidity of the pulse and 
fever, the cessation of vomiting, the regulation of the intestinal discharges, 
and the return of sleep. On the other hand, an unfavorable progress of 
the disease is denoted by a persistent decline in strength, increase of the 
feebleness and frequency of the pulse, coldness of the extremities, lividity, 
hiccough, and other signs of collapse. 

Treatment. The use of large doses of opium in the treatment of 
peritonitis has ever been the universal practice. The great tolerance of 
this medicine evinced by patients is most remarkable, and one case is 
reported where of opium and the sulphate of morphia, what was equivalent 
to four hundred and seventy-two grains of the former was taken in twenty- 
four hours. Complete rest is demanded throughout the disease. Even 
limited quantities of fluid are often quickly vomited, and only small pieces 
of ice are allowable for allaying the thirst. Violent hiccough is often one 
of the most obstinate symptoms to overcome. Warm applications to the 
abdomen, if grateful to the patient, are useful ; poultices are uncomfort- 
able from their weight. Sustaining measures are indicated in proportion 
as the symptoms denote failure of the vital powers. The nourishment 
should be concentrated, and as soon as collapse appears to threaten life, 
stimulants must be employed. 

FUNCTIONAL DERANGEMENTS OP THE LIVER. 

Writers have been wont to describe ten varieties of functional derange- 
ments of the liver ; all relating to circulation of blood within the organ, 
and to its secretory functions. It is sufficient, in this work, to treat of 
those affections only which are the most common. The terms biliousness 
and torpid liver were more frequently used twenty years ago than now; 
still, they are by no means obsolete at the present time. While the con- 
ditions which they express are somewhat vague and ill-defined, they are, 
by common usage and general acceptation, deserving of recognition, as 
indicating a train of symptoms with which but few are unfamiliar. 

Among the disorders of the liver, relating to circulation, the so-called 
active congestion is the most frequent. It is attributable to over-eating, 
especially of food of a stimulating quality, the use of alcoholic drinks, and 
condiments which excite the stomach, such as pepper and mustard. The 
excessive heat of tropical climates, India for instance, is supposed to give 
rise to it, and it is sometimes caused by anxiety and prolonged mental 
labor. The prominent symptoms indicative of congestion are a sense of 
fulness, weight, or tightness, in the right side of the abdomen, immediately 



298 DISEASES OF THE ABDOMINAL ORGANS. 

below the ribs; impaired appetite and digestion, a bitter taste in the 
mouth, offensive odor to the breath, nausea (and sometimes vomiting), pain 
in the head, flatulency, and a sallow complexion. In this disorder the 
tongue is usually large, pale, and flabby. Constipation and diarrhoea may 

alternate, the discharges being in some instances pale, in others greenish 
or blackish. 

The functional disorder which is due to a morbid deficiency of bile is 
commonly known as torpor of the liver. Those who suffer from this 
affection complain of languor, drowsiness, aching pains in the limbs, a dull 
pain over the region of the affected organ, often shooting up the right side 
to the shoulder, and not infrequently of backache. Digestion is much 
disturbed; there is furred tongue, a bad taste in the mouth, loss of appe- 
tite, intestinal irregularity, gaseous accumulations, rumbling, very offen- 
sive discharges from the bowels, and dark-colored urine. Headache, 
usually referred to the forehead, is very common; and when induced by 
indiscretions in diet, it is called " bilious " or " sick headache." Dizziness, 
dim vision, and spots floating before the eyes, are frequent results of over- 
eating, in those whose livers are functionally deranged. Palpitation of the 
heart is a frequent accompaniment, the pulse being irregular, and even 
intermittent ; circulation is disturbed, and cold extremities are the conse- 
quence. Patients suffering from this form of liver derangement are 
inclined to be irritable, moody, despondent, and hypochondriacal. After 
this affection has persisted for several months, diseases of the skin are 
liable to appear as a direct result. Not infrequently are observed dark 
patches on the skin, popularly called "liver spots." 

The measures to be employed in the treatment are mainly dietetic and 
hygienic. First in importance it is necessary to limit the quantity of 
food. Xo more should be taken daily than is absolutely demanded for the 
nourishment and support of the patient. It is indisputable that indul- 
gence in rich dishes, either fatty or sugary, produces a bilious condition ; 
therefore abstinence from all such articles promises relief. Some writers 
insist that meats should be excluded from the diet, and starchy food only 
be allowed; others recommend the former, and prohibit the latter. Doubt- 
less there are some patients who improve more rapidly if all meats are 
avoided, and fruits and farinaceous foods are alone indulged in. On the 
contrary, there are patients to whom a mixed diet is best suited. It will 
be necessary for each individual under treatment to learn to avoid those 
substances which experience has taught him tax his digestion. As a 
general rule, the bill of fare should be varied from day to day, but be as 
simple as possible at each meal. Considering the faet that vegetable food 
is much less likely to cause flatulency if taken alone, it will be well to 
divide the animal food from it, taking one at one meal and the other at 
another. Those vegetables which are almost always well borne are 
spinach, canned tomatoes, squashes, beet root, and French beans. Peas 



FUNCTIONAL DERANGEMENTS OF THE LIVEIt. 200 

must be very young and soft, and potatoes old and well cooked and 
mashed. The most delicate parts of cauliflower, only, are easy of diges- 
tion. Raw fruits should never be eaten at the end of a meal ; roast 
apples, if taken with a little cream and hardly any sugar, are no tax upon 
the assimilative powers. At separate meals a bunch of grapes, a few- 
strawberries, currants, or raspberries, with a crust of bread, aid, rather than 
impede, digestion. 

All bread should be stale or toasted, and, if it can be properly masti- 
cated, crust is preferable to crumb. Of other farinaceous foods it may be 
said that almost all depends upon the cooking. Pastry should be relig- 
iously excluded from the bill of fare, but flour or bread made into pud- 
dings can generally be tolerated. Semolina, tapioca, sago, and arrowroot 
are agreeable, light, and well borne. It will be necessary to forego the 
use of cheese, as it almost always causes discomfort. In the selection of 
meats, the easily digestible should be chosen. Boiled fish may properly 
enter largely into the diet of those of a bilious habit ; fried fish are never 
allowable. Careful, slow mastication of articles of food, and rest after 
meals, are desirable, in order to reduce the demands upon the liver. As 
regards beverages, one author says : It is notorious that small quantities of 
aj)parently simple food, such as eggs or milk, will disturb bilious persons ; 
equally well known is the effect of alcoholic beverages. A glass of port, 
a' single glass of Champagne or Sauterne in another, a glass of malt in a 
third, will set up serious hepatic disturbance. Each must learn to avoid 
his own poisons. As a general rule, wines and ales should be wholly dis- 
carded. Fresh air, sea air especially, and exercise, as far as the powers 
permit, frequent bathing, and the abandonment of severe mental labor, are 
recommended. 

As regards medicinal remedies, Fothergill says : " Alkaline saline 
purgatives are indicated. They should be taken in the form of Carlsbad 
salts, Vals or Vichy water, Friedrichshall, or Hunyadi Janos, or a combi- 
nation of Rochelle salts and sulphate of soda every morning, on rising ; 
together with a tumblerful of water, cold, lukewarm, or warm, according 
to the patient's tastes and requirements. After a copious liquid motion 
before breakfast, and a second one after, a bilious person usually feels light 
and fit for work ; and, moreover, can digest his food better, and take 
greater quantities without disturbance. Such treatment requires a little 
time to make its good effects manifest, and the patient must be encouraged 
to persevere. So long as there is a bitter taste in the mouth in the morn- 
ing, the purgation must be continued. When the tongue is clean and the 
bitter taste gone, then the purgation need only be occasional." 

In commencing treatment in functional derangements of the liver, and 
in the so-called "acute bilious attacks," induced by indiscretions in eating, 
or other causes, it is often advisable to employ the following : — 



800 DISEASES OF THE ABDOMINAL ORGANS. 

I£ Mass. hydrarg gr. xvj. 

Pulv. ipecac gr. iv. 

Ext. taraxaci 3 ij. 

Ft. pil. Xo. 24. Sig. : Dose, one, three times daily, one-half hour before eating. 
(In making this pill, the druggist must first well dry his extract, and use a small quan- 
tity of powdered licorice.) 

After these pills have been taken for six or eight clays, they may be 
discontinued, and the treatment advised in the foregoing should then be 
employed. After the liver derangement is under control, and the promi- 
nent symptoms have subsided, then, if needed, tonics are admissible; until 
this result is attained, however, they should never be employed. One of 
the most popular errors chargeable to bilious patients is the employment 
of tonics while marked disturbance of the liver exists. Iron, more espec- 
ially, they often take for weeks ; it is not only contra-indicated, but does 
positive harm. At the proper time, if a tonic is required, either small 
doses of quinine, or the elixir of calisaya bark, iron, and strychnia is 
the most deshable. 



CHAPTER II. 

JAUNDICE. 

Jaundice is a yellow discoloration of the skin, due to the presence 
of the coloring matters of the bile. It is, strictly, never an individual dis- 
ease, but is an effect or a symptom, dependent upon various affections. 
Thus, it is a frequent accompaniment of diseases of the liver, pancreas, the 
upper portion of the intestine, etc., and is particularly observed in can- 
cerous affections of these organs. There are two varieties of jaundice, the 
obstructive and non-obstructive. In the former class, there is either 
absorption of the biliary coloring-matter, and of the biliary salts, after their 
formation in the liver, — the bile being prevented from passing into the 
intestine by some mechanical obstruction, — or the pressure made by the 
accumulated fluid upon the vessels serves to interfere with the process of 
secretion, and thus prevents the due elimination of the coloring matter 
from the blood. In the non-obstructive class, the jaundice is induced by 
changes in the blood itself, wherebv the coloring matter is set free in 
excess. 

One of the functions of the liver is to remove noxious matters from the 
blood. Among these substances is the yellow principle upon which the 
color of the bile depends, and which is probably formed in the blood. As 
a result of some morbid change, the secretory functions of the liver may 
be impaired or suspended, by which means the yellow matter is accumu- 
lated in the circulation. This accumulation of pigment, if not got rid of 
in some manner, might tend to derange some of the vital processes. 
Nature appears to have provided a safeguard from this danger, by render- 
ing almost all the other secretory functions sensible to the stimulus of the 
yellow matter in excess, and capable, under this exciting influence, of sep- 
arating it from the blood. Thus the bile coloring matter is thrown out by 
the kidneys and skin, and deposited in the tissues, imparting the character- 
istic hue to the various substances with which it is brought in contact, 
while the clay-colored discharges indicate its absence from the intestine. 

In considering jaundice from obstruction, it may be said that whatever 
causes closure of, or pressure upon, the biliary ducts, to any considerable 
extent, will necessarily produce this disease. Among all other causes of 

301 



302 DISEASES OF THE ABDOMINAL ORGANS. 

the affection, there are two observed ranch more frequently than others. 
The first of these is acute catarrhal inflammation of the mucous membrane 
lining the bile-ducts ; the second is the obstruction of the ducts by biliary 
ili. Jaundice, occurring without obstruction, is due to some poison 
acting directly upon the blood, or as a secondary consequence of the 
obstructive form of the disease. 

When jaundice exists, to determine the cause is of the first impor- 
tance. In a general way, it is said that, if the affection appears suddenly 
and painlessly, while the patient is seemingly in good health, it is probably 
of emotional origin, and transitory. When it depends on disease or injury 
of the brain, acute atrophy of the liver, snake-poison, or an infectious 
fever, it is always associated with mental disturbance. If it be attended 
with fever, and well marked, it is secondary to inflammation of biliary 
passages, pneumonia, blood-poisoning, or infective inflammation of the 
largest blood-vessel of the liver, called the portal vein. If it occurs sud- 
denly, and is preceded by paroxysmal pain and vomiting, it is caused, nine 
times out of ten, by gall-stones. When preceded by typical symptoms of 
stomach and intestinal inflammation, it is obviously of catarrhal origin. 
Impassable obstruction of the passage leading from the gall-bladder to the 
intestine is shown by great intensity of jaundice and clay-colored stools. 
Jaundice caused by sudden obstruction of the biliary passages, is always 
associated with paroxysmal pain and nausea. During the existence of this 
affection, if the intestinal discharges, previously clay-colored, suddenly 
return to the normal color, the diagnosis of obstruction is confirmed. 
Repeated attacks of jaundice point to the probability of gall-stones. If the 
disease comes on slowly, without antecedent colic or catarrh, and without 
attendant evidence of impaired health or circulatory disturbances, the 
pressure of some growth on the walls of the canal leading from the gall- 
bladder to the intestine may be suspected. Slight but persistent jaundice 
is usually found co-existing with valvular disease of the heart, or some 
diseases of the lungs, or cirrhosis of the liver. If abdominal dropsy is 
associated with it, the disease is either cirrhosis or cancer of the liver. 

Yellowness of the external coat of the eye and skin takes place after a 
certain amount of bile has entered the circulation. Prior to the appear- 
ance of the jaundice, the urine becomes cloudy, and gives to linen a yellow 
stain. The perspiration contains bile pigment, and the body linen may 
also be stained yellow, especially from the abundant secretion in the armpit. 
According to Flint, bile in the blood acts as a sedative. The heart's action 
is usually diminished in frequency. The pulse frequently falls to fifty, forty, 
or even lower, in cases in which the jaundice is not associated with acute 
inflammation or fever, and, if thus associated, the frequency of the pulse is 
less than if jaundice did not co-exist. The effect is attributed to the pres- 
ence in the blood, not of the pigment, but of the biliary acid salts. The 
temperature of the body may be lowered. The respirations diminish in 



JAUNDICE. 303 

frequency in proportion to the effect on the circulation. The mental facul- 
ties are dull, and there is a disposition to somnolency. Itching of the sur- 
face, especially in the armpit and groin, troublesome more particularly at 
night, is an occasional symptom. It is sometimes a source of great annoy- 
ance. An occasional complication is nettle-rash, denoted by the character- 
istic elevations on the skin, or wheals, which present a deeper yellowness 
than the surrounding integument, and occasion intense itching. 

When jaundice is associated with inflammation of the stomach and 
upper portion of the intestine, there are loss of appetite, nausea, and some- 
times vomiting, a furred tongue, thirst, gaseous distention, and more or 
less pain in the region of the pit of the stomach, and tenderness in that 
situation. When the inflammation does not co-exist, the appetite may be 
but little or not at all impaired. In nearly all cases of jaundice, the 
bowels are constipated. If the stoppage of the bile-duct is complete, the 
discharges from the bowels are clay-colored ; if, on the other hand, it is 
only partial, they may be more or less of the yellowish or brownish color 
of health. The bile acts as a disinfectant, and when absent from the 
stools, they emit a putrescent odor. 

The prognosis in this affection depends upon the diseased conditions 
with which it is associated. When it co-exists with gastro-intestinal 
inflammation, recovery generally takes place in from three to five weeks. 
If there is permanent obstruction, nutrition may for a time be but little 
affected, but, sooner or later, the patient becomes anaemic ; there is 
progressive loss of weight, the vital powers gradually fail, and the termina- 
tion is fatal. In other forms of jaundice, the prognosis varies with the 
cause, and is determined by the disease with wdiich it is associated. 

In reference to the management of jaundice, in those cases in which 
there is permanent closure of the biliary ducts, and which will inevitably 
run on to a fatal termination, as in cirrhosis, cancer of the liver, etc., the 
treatment can only be palliative, relieving pain and sustaining the vital 
forces. In that class of cases which may be termed doubtful, — as, for 
instance, jaundice occurring in fevers, after snake-bites, in other forms of 
blood-poisoning, in abscess of the liver, and in certain other states, — 
the treatment is the same as that of the various diseases on which they 
depend. In cases unassociated with organic disease, and in which there is 
reasonable hope for recovery, the treatment is generally to be addressed to 
the subacute inflammation of the stomach and intestine, with which the 
jaundice is most commonly associated. 

In the treatment of this disease it is important to carefully regulate 
the diet, supporting the patient by nourishing food, and avoiding fatty 
substances, as well as starch, sugar, and alcoholic stimulants. In persis- 
tent jaundice it will be well to supply a substitute for the retained bile in 
artificially prepared ox-gall, in from five to ten grain doses, two or three 
hours after meals. The functions of the skin should be maintained by 



304 DISEASES OF THE ABDOMINAL OKGANS. 

warm baths, and by guarding against exposure to eold. Cream-of-t.artar 
water, taken freely, will excite increased activity of the kidneys. If 
inflammatory conditions of the liver co-exist, leeches or blisters, or both, 
may be resorted to. If there is constipation, it will be necessary to 
administer an occasional laxative; it should only be given when needed, 
and then the mildest form is to be preferred. The mineral waters, 
Congress, Kissingen, and Vichy, will frequently suffice. When pain exists, 
opiates will be demanded, and, if there is reason to believe gall-stones are 
passing, a physician can rarely be dispensed with. Accidental symptoms 
appear in nearly all cases, and claim appropriate measures. It is important 
to bear in mind that jaundice, in the majority of cases, is associated with 
and depends upon an inflammation of the stomach and upper part of the 
intestines. This form of the affection is self-limited, and naturally tends 
to recovery, after a short time, unless the cause which induces it continues 
active. When the discharges from the bowels have been clay-colored, 
and suddenly the stools assume a normal appearance, rapid improvement 
may be expected. It should be remembered that yellowness of the skin 
and eyes continues for some time after the absorption of the bile has 
ceased and recovery commenced. The urine affords the most reliable 
evidence of the condition ; if it has been previously deeply colored, the 
affection is to be considered as having ended when the natural color is 
restored. 



CHAPTER III. 
DISEASES OF THE KIDNEYS. 

The term "Bright's disease" is used to designate a variety of impor- 
tant changes in the kidney. In 1827, Dr. Bright first called the attention 
of the profession to this series of diseases, and in his honor his name has 
since been coupled with them. Other systematic investigators subsequently 
added to the knowledge of kidney diseases, and at this time sharp distinc- 
tions are drawn between them. As these affections are often combined 
with one another, and present many symptoms in common, even the most 
intelligent physicians and skilful diagnosticians often find it difficult to 
discriminate between the chronic forms. Again, it is believed by many 
that the varieties of chronic Bright's disease should not be regarded as 
distinct affections, but rather as different manifestations of one and the 
same disease. It is, therefore, advisable, in this work, to simplify the clas- 
sification, and to consider the two important forms, namely, acute and 
chronic Bright's disease. 

Before entering upon the study of these diseases, it is well to briefly 
consider a few facts which are pertinent to the subject. Doubtless there 
is no organ of the body which is more often wrongfully accused of per- 
forming its functions imperfectly than the kidney ; it is equally true that 
of the symptoms which characterize its diseases the public generally are 
proverbially ignorant. By many, a pain in the back is at once construed 
as an evidence of kidney trouble, while, as a matter of fact, not only is it 
rarely prominent, but is generally wanting in diseases of that organ. 
Physicians themselves are in a measure accountable for this deplorable 
assumption. Very often patients consult them for obscure disorders, the 
exact nature of which it is not always easy to determine; a very ready and 
convenient diagnosis in such cases is kidney derangement, and with this 
the individuals are generally well content. People should know that pain 
in the back occurs in such a variety of diseases and functional affections, 
that, when considered alone, it has very little diagnostic significance, and 
the kidney is almost the last organ to be considered as concerned in its 
production. 

305 



pis: s vRdomin ans. 

I: is -:ing to note upon how trivial a basis the 

'- sease is set up. as Dr. Edes - ys, to the glory of quacks 

and mineral waters. The disappearance of a sediment, which may be due 
simply to a greater dilution of the urine, to the subsidence of a slight 
febrile attack m to the application of heat, has been adduce 

evidence of the great efficacy of a quack medicine in the cure of k * kidney 
complaint.*' Persons are often deeply concerned if their urine becomes 
cloud v ; in winter, especially, physicians hear this emphasized as an alarm- 
ins: indication of disease, Yet were the complainants to remove it 
warm room, and allow it to remain there for a short time, this precipitate, 
which is thrown down by cold, would again become dissolved by heat, and 
nothing unusual would be noticed in the appearance of the excretion. 

- an uncontrovertible fact that the diagnosis of kidney disease cannot 
with absolute certainty be made, even by the most skilful of the medical 
profession, without both a microscopical and chemical analysis. This should 
be remembered, and if a physician renders an opinion in a case without 
this indispensable procedure, the patient should know that it is mt 
speculative, and that the man whom he con- is either a base prete:: 
or one indifferent to the welfare of those who entrust their health to his 
keeping. In either case, all such advisers should be avoide 

In discussing the subject of kidnej liseases, the writer will endeavor 
to familiarize the reader with the most prominent symptoms, that he 
be able to make a presumptive diagnosis H will in all sases, ver, 

need the assistance of an intelligent physician, before the existence : 
these diseases can positively be determined. 

ACUTE BRIGHT3 DISZASZ. 

Usually the first symptom which points to the existence of this disea se 
is a dropsy, exhibiting itself by a slight pnffiness on the eyelids and around 
the eyes. Coincident with this manifestation, there is more or less fever, 
which, in some cases, is preceded by chilis, or chilly sensations. There are 
also loss of appetite, thirst, rest. 2ssnes&, headache, and occasionally pain and 
tenderness in the loins. Pain is, however, rarely prominent, and is 
wanting. Nausea and vomiting are frequently early symptoms in the affec- 
tion. The dropsy usually extends rapidly, and soon becomes general; 
occasionally it first appears in the feet and ankles. The amount of swelling 
var: erably in different cases: in the mild forms of the 

it is not The quantity of urine is usually diminished, and i 

v scanty; it is high-colored, and sometimes smoky in appearance. 

In cases which run a favorable course, improvement soon begins after 
the symptoms described have become manifest* ; :he urine increases in 
quantity, the dropsy disappears, the headache ceases, general functional 
activity is renewed, and, usually, within two oi is 



ACUTE BRIGHT'S DISEASE. 307 

completed. In a certain proportion of cases, instead of improving, the 
patients steadily grow worse. The dropsy increases, until the entire body 
becomes enormously swollen, and the surface assumes a peculiar pale, waxy 
appearance. More or less dropsical effusion takes place into the pleural 
cavity, and difficult breathing is the consequence; in some cases the quan- 
tity of fluid is sufficient to endanger life. As the disease progresses, head- 
ache becomes more persistent and severe, and other marked nervous symp- 
toms are associated. The patient grows exceedingly restless, muscular 
twitchings occur, and these may be speedily followed by convulsions, coma, 
and death. In severe cases, coma comes on gradually, and life is termi- 
nated without the appearance of convulsions. 

Loomis defines still another type of acute B right's disease which is 
occasionally met. According to his description, it is ushered in by 
violent symptoms. The patient is seized with a chill and intense pain in 
the back ; there are delirium, great nervous disturbance, urgent brain symp- 
toms, and the sufferer may pass into a state of coma, and die within two 
or three days. The chill in these cases is followed by very high fever; 
there is often almost complete suppression of the urine, perhaps not more 
than half a teacupful being secreted in twenty-four hours. The delirium 
which is present so closely resembles that of meningitis, it is often difficult 
to differentiate between the two conditions. Rapidly following the acces- 
sion of the ushering-in symptoms, dropsy of the face is developed; the 
patient soon becomes comatose, and usually the attack terminates fatally. 
Even if patients seemingly recover from the acute stage, the kidneys will 
be permanently injured, and the symptoms of chronic Bright's disease 
will, after a time, be presented. 

The majority of cases of acute Bright's disease are developed during, 
or follow, scarlet fever. The disease also sometimes occurs in the course 
of articular rheumatism, typhoid and typhus fevers, erysipelas, pneumonia, 
blood-poisoning, dysentery, carbuncles and large abscesses in different 
situations, and in measles. It occasionally follows diphtheria and epidemic 
cholera. A frequent cause of the affection is pregnancy; it also results 
from exposure to cold, or other sudden arrest of the action of the skin, 
and from excessive indulgence in alcohol. Authors generally agree that 
intemperance in the use of spirits is not alone capable of producing acute 
inflammation of the kidneys; they attribute the causative influence to the 
sudden changes of temperature to which intoxicated persons subject them- 
selves in consequence of such indulgence. It is a fact, nevertheless, that 
this disease has followed wanton indulgence in alcohol, without any expo- 
sure to cold. 

The danger in acute Bright's disease is from poisoning by waste 
matters which the kidneys are unable to excrete, and which accumulate 
in the system. These poisonous matters, acting upon the brain, render 
the great nerve-centres abnormally excitable, in which condition they are 



80S DISEASES OF THE ABDOMINAL ORGANS. 

extremely sensitive, and convulsions are easily induced by a variety of 
influences to which the patients are then subjected. When the accumula- 
tion of the poisonous matters is excessive, or when, for any reason, it goes 
gradually on without the production of convulsions, the tendency is towards 
coma, a more essential feature of the so-called uraemia than are convulsions. 
Exclusive of this blood-poisoning, and serious complications, — such as 
pleuritis, pericarditis, peritonitis, meningitis, and pneumonitis, which are 
liable to be developed in the course of the affection, — the prognosis of 
acute Bright'* disease is favorable. It is self-limited, and seldom continues 
more than two months. In a small proportion of cases, patients pass from 
the acute into the chronic form of the disease. During the course of the 
former, headache is a symptom of great significance. If it is persistent 
and severe, it indicates a dangerous degree of blood-poisoning, and coma 
or convulsions are liable to occur. Often this symptom is relieved by a 
spontaneous attack of vomiting. 

In the treatment of acute Bright's disease, efforts should first be 
directed to exciting greater activity of the skin and the intestines, forcing 
these organs to perform the labor of eliminating waste products, which the 
kidneys are for the time incapable of doing. The patient should be con- 
fined to the bed, in order to maintain a uniform warmth of the surface. 
There are several methods of increasing the function of the skin. The 
object may be attained by rolling the patient in blankets wrung out of hot 
water, or by the bath devised by Sir James Simpson. In giving the latter, 
the only appliances needed are six or eight soda-water bottles, and as many 
woollen stockings. Each bottle is filled with hot water, and tightly corked. 
Then a stocking is wrung out of hot water, so as to be moist but not drip- 
ping, and drawn over the bottle as it is over the foot when put on. The 
bottles, so encased in the moist stockings, should then be packed around 
the patient, between the legs, etc., and over all sufficient bedclothing should 
be placed to retain the steam, which is rapidly generated. In from twenty 
to thirty minutes a thoroughly free perspiration is produced. If the 
bottles are then removed, and the patients well covered with woollen 
blankets, the sweating will continue. Active perspiration should be pro- 
longed for from one to two hours, according to the exigency of the case. 
After the bath, the removal of the patient to another bed, which has been 
previously thoroughly well aired and warmed, is advisable. In very urgent 
cases, when coma or convulsions are threatened, it may be necessary to 
repeat the baths daily. 

Early in all attacks it will be well to move the bowels briskly, with ten 
grains of jalap in two drachms of bitartrate of potash. The subsequent 
use of cathartics will be indicated in proportion to the amount and situa- 
tion of the dropsical effusion, and the danger of a large accumulation of 
poisonous matters in the blood. Exhaustion can be produced by continued 
sweating and the frequent use of powerful purgatives. This fact should 



CHRONIC B RIGHT'S DISEASE. 309 

be remembered, and, after the action of the skin and intestines is once 
excited, the baths and cathartics should only be employed as their need is 
manifested. In cases in which suffering and danger from impeded respira- 
tion are incident to an effusion into the pleural cavities, their immediate 
use is demanded. 

The next indication in treatment is to increase the action of the 
kidneys, by mild remedial measures. Pure water and cream-of-tartar 
water should be taken as freely as can be done without inconvenience. 
The following preparation increases the excretory power of the kidneys: — 

J^, Potass, acetatis 3 vj. 

Infus. digitalis . 5 V J« 

Ft. mist. Sig. : Dose, two teaspoonf uls, four times daily. 

Mustard poultices and hot fomentations to the back draw the blood 
from the kidneys, and tend to lessen the congestion in them. The diet 
should be restricted to milk and thin gruels. Skimmed milk is highly 
advocated; besides being nourishing, it increases the activity of the 
kidneys. If this plan of treatment is systematically carried out from the 
very commencement of the attack, in the majority of cases the urine will 
speedily become copious and the dropsy pass away. As soon as the natural 
functional activity of the kidneys is re-established, the mixture of potash 
and digitalis should be discontinued; the diluent drinks and the dietetic 
treatment should be persisted in until the urine becomes perfectly normal. 
This fact can only be determined by microscopical examination and chem- 
ical analysis. If coma or convulsions occur during the course of acute 
Bright's disease, inhalations of ether, injections of chloral-hydrate, or 
morphia subcutaneously, will be indicated. 



CHRONIC BRIGHT'S DISEASE. 

" Chronic Bright's disease," says Wm. Roberts, " in a great majority of 
instances, begins slowly and imperceptibly. It is rarely detected until 
it has already existed many months — it may be years. The attention of 
the patient is at length awakened by the gradual failure of his strength, 
the increasing pallor or sallowness of his complexion, and his disinclination 
to exertion ; perhaps his suspicions are aroused by a little pumness under 
the eyes, a slight swelling of the ankles at night, unusually frequent calls 
to void urine, or shortness of breath. In other cases these premonitions 
are altogether wanting, or perhaps they pass unheeded. The fatal dis- 
organization of the kidneys proceeds silently and amid apparent health ; 
and then suddenly declares itself by a fit of convulsions, rapid coma, loss 
of sight, pulmonary dropsy, or a violent inflammation. Or, again, the 
disease creeps on stealthily, in the wake of some pre-existing chronic dis- 
order — phthisis, caries, necrosis, joint-disease, constitutional syphilis, 



310 DISEASES OF THE ABDOMINAL ORGANS. 

chronic alcoholism, or exhausting suppuration. Or it may be a sequela of 
acute Bright's disease. Lastly, the disease may lie concealed for an unde- 
termined period, and then reveal itself after exposure to cold, or a fit of 
intoxication, in the guise of an acute attack, with rapid general dropsy, 
and scanty, albuminous urine." 

In some forms of Bright's disease, dropsy is a prominent symptom; in 
others, it is never very marked. In the latter there is usually some swell- 
ing of the lower extremities, at night, after prolonged exertion, such as 
standino- or walking; this generally disappears in the morning, on rising. 
In the general appearance of the urine there is practically nothing distinc- 
tive of disease of the kidneys. It may be exceedingly scanty and high- 
colored, or it may be more abundant than normal, clear and light in color; 
generally towards the end of life the quantity is diminished. Of little or 
no diagnostic significance is the appearance of a sediment in the urine, 
as it is present in some cases and absent in others. 

In all forms of Bright's disease, symptoms referable to the digestive 
system are more or less prominent ; indigestion, or dyspeptic disorder, is 
common. In some cases vomiting is a persistent symptom. It is a salu- 
tarv effort on the part of the stomach to expel from the system the poi- 
sonous matters retained through imperfect action of the kidneys. It is 
sometimes the chief manifestation of such poisoning, and when persisting 
without obvious cause, vomiting should always excite suspicion of kidney 
disease although no other symptoms co-exist. The appetite early becomes 
capricious or is lost. The pallor of the countenance is due to anaemia, 
which is more marked in cases of general dropsy. Diarrhoea is not a 
constant symptom, although it sometimes becomes persistent. The skin is 
more often dry and harsh ; and, in patients who have no regard for cleanli- 
ness, not infrequently the perspiration emits distinctly the odor of urine. 
Difficult breathing may exist in a marked degree; it is generally due to 
pleural effusion or dropsy of the lung, and it may proceed from a poison- 
ous effect on the nervous centre presiding over respiration. 

Headache is an exceedingly common symptom, and often it is the first 
which prompts the patient to seek medical advice : not infrequently it pre- 
cedes other symptoms for months. There is but little which is distinctive 
about it, except its frequent recurrence ; in character, the pain is hardly to 
be distinguished from a " nervous headache." Attacks of vertigo are not 
infrequent. The vision is more or less affected in a large proportion of 
cases; partial or complete loss of sight occasionally occurs. Coma and 
convulsions are the most important symptoms referable to the nervous 
system, and they are present in a large proportion of cases. Convulsions 
are generally preceded by persistent headache, vertigo, and mental excita- 
tion, sometimes amounting to delirium. In many cases coma comes on 
gradually, the patient having been more or less somnolent or dull for 
several days before becoming profoundly comatose. Convulsions may pre- 



CHUONIC BRIGHT'S DISEASE. 311 

cede or follow coma; they occur in paroxysms usually repeated at short 
intervals, and are epileptiform in character. There are a large variety of 
affections which complicate Bright's disease, or occur as secondary dis- 
eases; all important organs of the body are more or less involved in the 
abnormal changes. 

The course and symptoms vary much in different cases. In some, 
there are remissions, periods when the disease is apparently arrested and 
even recovery seems possible. In other cases the course is steadily pro- 
gressive to a fatal termination. The duration of Bright's disease is uncer- 
tain. In all advanced cases the prognosis is extremely unfavorable. 
When once Bright's disease is fully established, the kidneys can never be 
restored to their normal integrity. Its progress is, however, in many cases 
slow, and troublesome symptoms may be long delayed by judicious man- 
agement. 

To recognize the indications of Bright's disease in the earlier stages, 
and to appreciate the danger which they foretell, is of the utmost impor- 
tance. For the reader to form a presumptive diagnosis will, in many 
cases, be possible ; to confirm it, the microscope and a careful chemical 
analysis will be necessary. When the fact that chronic disease of the 
kidneys exists has been established, then to determine what form of 
degenerative changes is going on is the next important step. To dis- 
tinguish between them will require the most careful and painstaking 
observations ; the power of discrimination is only given to the intelligent 
and thoroughly educated physician. To him also must be intrusted the 
use of remedial measures. The treatment will be largely symptomatic, 
and no rule can be laid down alike applicable in all cases. The indiscrimi- 
nate use of medicinal agents in Bright's disease is attended with the great- 
est danger, as remedies which in one instance are beneficial may be in 
others injurious in the highest degree. 

There are certain hygienic and dietetic measures which all patients 
suffering from disease of the kidneys should employ ; their importance 
cannot be overestimated, and they may properly be herein considered. 
It should be remembered that, as Fothergill says, although in slightly 
changed language, wherever a chronic disease pre-exists then acute disease 
is most formidable. In the consumptive, acute pneumonia is ever to be 
dreaded ; the old standing mischief is lighted up as a fire by the acute 
intercurrent disease. In chronic debility of the stomach, acute indigestion 
quickly sets up grave disorder. In chronic disease of. the liver, acute 
hepatitis becomes most serious. And so in chronic kidney diseases, the 
matter to be avoided is the conditions of acute congestion, or even of 
acute inflammation of the kidneys, which are so apt to occur in the sub- 
jects of chronic changes in those organs, and to which pre-existing disease 
renders them so liable. The means to be adopted lie largely in the con- 
nections with the skin and with the diet. It is of much importance to 



312 DISEASES OF THE ABDOMINAL ORGANS. 

keep the skin warm, both from the effects of cold in producing internal 
congestion, and from the aid given the kidneys by the functional activity 
of the skin. Consequently the subject of Bright's disease should ever be 
warmly clad. The tendency of the malady is to produce a dry and 
unperspirable skin, so that the impaired kidneys get little assistance from 
cutaneous activity. Flannel from the neck to the wrists and ankles, and 
even "fleecy hosiery," must be worn in the daytime, and flannel night- 
dresses must be used for bed wear. Changes of temperature must be as 
carefully followed as in India, where it is necessary at some seasons to 
dress three or more times a day, for the cool morning, the hot noon, and 
the chill evening. The shoes and boots must be stout and well lined, and 
contain an inner sole of cork, felt, or even fur. All exposure to wet must 
be followed by a change of boots, even when it is in no way necessary to 
change the clothes, but all damp clothes should be changed without delay. 
The subjects of chronic Bright's disease live, as it were, over a volcano, 
and the slightest carelessness may be followed by the gravest conse- 
quences ; what would produce but a mere cold in others may induce a 
fatal attack of intercurrent inflammation in them. 

Travelling and long sea-voyages are recommended when possible; a 
change from a moist, variable climate to one dry and of uniform tem- 
perature promises good results. All debilitating influences should be 
combated, and both mental and bodily relaxation sought. The use of 
alcoholic stimulants will scarcely ever be warranted. On this subject 
Chambers says: "Whether alcohol or cold be the sharper blade of the 
shears so apt to cut short life's thread by Bright's disease I care not greatly, 
inasmuch as it cannot be questioned that both of them have that tendency. 
It is their union which is so irresistible a foe to the poorer working 
classes who come to the hospitals, and it is the avoidance of that union 
which protracts the lives of our wealthy patients." 

The milk diet has been employed in Bright's disease, and its value is 
unquestionably great. When patients have been confined to this article of 
food alone, many symptoms have improved and remissions of the disease 
been secured. Some will find it difficult, if not impossible, to submit to a 
diet exclusively of milk; when other food is demanded, farinaceous sub- 
stances are to be preferred. Fish, vegetables, fruits, puddings, etc., should 
form a large portion of the dietary ; animal food will, in many cases, be 
demanded and should not be interdicted. With patients it is a popular 
prejudice that indulgence in drinking-water leads to dropsy. In all cases 
pure water is an active agent which tends to increase the flow of urine 
and assists in the expulsion of poisonous matters; its free use should, 
therefore, be encouraged. 



CHAPTER IV. 

DIABETES MELLITUS. 

The name diabetes mellitus is applied to a disease generally chronic in 
its course, and which is characterized by the appearance of grape-sugar, or 
glucose, in the urine. An increased flow of urine is also usually a notable 
feature of the affection. The sugar, which is excreted by the kidneys, is 
known to pre-exist in the blood ; but the true seat and nature of the 
morbid changes from which it primarily proceeds are as yet undeter- 
mined. 

The increase in the quantity of the urine is one of the earliest and 
most constant symptoms of diabetes ; only in extremely rare cases is the 
quantity normal or abnormally small. With this symptom there co-exists 
thirst, which becomes urgent in proportion to the increased action of the 
kidneys. As a more abundant flow of urine is secreted, its color becomes 
lighter, owing to dilution of the coloring matter, and if the quantity is 
excessively great it is almost entirely colorless and as clear as water. The 
odor of diabetic urine is somewhat characteristic; if not immediately after 
its evacuation, it, in a few hours, on standing, very often becomes pecul- 
iarly aromatic, compared by some to the odor of hay and of apples. If 
much sugar is present, it is perceptible to the taste. Saccharine urine is 
irritating, and causes a burning, itching, stinging sensation in the parts 
from which it is evacuated. 

With the occurrence of thirst there is almost invariably an increase of 
the appetite; much more food is taken than in health, and even unusually 
hearty food, especially the saccharine and starchy, always seems able to 
appease the hunger for a short time only. The abnormal appetite coupled 
with persistent decrease of weight should excite suspicion of the disease. 
The patient's sense of taste is commonly perverted, being described as 
stale and clammy, and, not infrequently, too, decidedly sweet. In many 
instances the breath has a sweetish offensive odor. The dryness of the 
mouth and throat is a source of considerable discomfort. The tongue in 
some cases is moist and coated; in others it is increased in size, glazed and 
red. In advanced cases the gums are softened and swollen ; they are 
either pale or reddened, and bleed readily on pressure. The teeth of 
diabetics decay rapidly, and often become loosened. 

313 



314 DISEASES OE THE ABDOMINAL ORGANS. 

When the excretion of urine and sugar is very great, the skin becomes 
dry, rough, and harsh, and it is not uncommon for fine branny scales to 
form. Sweating is comparatively rare, and when it occurs sugar generally 
appears in the perspiration. As the disease progresses, itching of the 
skin becomes a source of much annoyance. The abrasions occasioned by 
scratching, as well as other slight injuries of the skin, are healed with 
great difficulty. There is a marked tendency in diabetic patients to 
inflammation of the skin, and the formation of carbuncles and abscesses. 
Gangrene of toes, and even of a whole limb, has been known to occur. 
Dropsy of the lower extremities very often appears in protracted cases. 

After the disease has existed for some time, the decrease in weight 
and the decline of mental and physical powers are more or less marked 
and progressive. Diabetics usually become capricious, irritable, and show 
a tendency to sadness and despondency; not uncommonly they are dull 
and disinclined to bodily or mental exertion. Severe headache is of 
frequent occurrence. In severe cases the countenance becomes changed; 
it usually wears a depressed, anxious expression. Disturbances of vision 
are not infrequent, and impairment of the hearing, without recognizable 
cause, has been noted. Digestion often remains for a long time unim- 
paired ; temporary disturbances are, however, not infrequent, and both 
vomiting and diarrhoea may occur. Many patients complain of a constant 
sinking feeling at the pit of the stomach. The temperature of the body 
is lowered ; the pulse-rate and respirations are below the normal. 

A positive diagnosis in diabetes cannot be made without a chemical 
analysis of the urine ; when the existence of the disease is suspected, a 
specimen should be submitted to a competent physician. Several exami- 
nations will be necessary, and, in every instance, the urine should be tested 
by more than one method. Among the simplest and convenient tests is 
the employment of the solution of the chloride of iron. If a small 
quantity of this agent is added to diabetic urine, it changes the color to a 
shade between a claret and a brown. What causes this color is unknown, 
but it is believed to be due to the presence of diacetic acid. 

The prognosis, as far as the final result of diabetes, is unfavorable; a 
permanent and complete recovery cannot be expected. In many cases, if 
not too far advanced, under proper dietetic treatment, improvement may 
take place, and the patients for a long time enjoy comparatively good 
health. With the disappearance of the sugar in the urine, other disorders 
subside, and the*vital powers are in a measure restored. If, however, the 
general system has undergone much deterioration, the decline is generally 
progressive. The age and weight of the body has a decided influence on 
the course of the disease. The younger the patient, the more unfavorable 
the prognosis. Corpulency is considered distinctly an advantage. The 
usual duration of diabetes extends over several years. The development 
of the disease is imperceptible, and in most cases it exists for a long time 






DIABETES MELLITUS. 315 

before it is discovered. A very large proportion of diabetics are cut off 
by intercurrent affections; consumption was the immediate cause of death 
in forty-three per cent of the cases analyzed by Griesinger. In cases which 
pursue a fatal course without complications or pre-existing affections, 
death may take place suddenly by complete exhaustion, or occur in the 
course of a few days with symptoms indicative of blood-poisoning. 

The essential treatment of diabetes is dietetic. Very little assistance 
can be expected in any instance from the use of drugs, and they are 
positively valueless unless the diet is properly restricted. The prime 
object of treatment is to reduce the amount of sugar in the blood, by 
withholding from the food, almost entirely, sugar in any form, and all the 
starchy constituents of food capable of being transformed into sugar. 
It will require great strength of will to adopt and persevere in the 
dietetic restriction, but all diabetic invalids should realize that in no 
other way can life be prolonged, and the risk of intercurrent maladies 
be diminished. 

M. Bouchardat, Professor of Hygiene at the University of Paris, is 
doubtless the great authority on the dietetic regimen of diabetic patients. 
He gives the following list of eatables the chemical composition of which 
makes them injurious in this disease : Sugar, bread, or any kind of pastry, 
rice, maize and other starchy grains, potatoes, arrowroot, tapioca and sago, 
also manufactured starches, such as macaroni, vermicelli, and semolina. 
He religiously excludes from the diet, vegetable seeds, peas and beans of 
all varieties, and chestnuts, radishes, turnips, beet root and carrots, all 
preserved fruits, apples and pears ; honey, milk, beer, cider, stout, and 
sparkling wines, lemonades, and similar sweetened acid drinks. 

This eminent authority states that diabetics may eat without fear meat 
of all kinds, brown or white, boiled, roasted, or grilled, and seasoned with 
any sauce pleasing to the palate, provided there be no flour or sugar in 
it. Chambers says : "To the curious gourmet affected with diabetes it 
may be mentioned that Professor Bouchardat especially commends the 
flesh of carnivorous animals, and advises their trying cat, dog, and fox. 
Probably larks, robins, and ducks, will be more to their taste. The liver, 
however, should not be eaten, and by removing the fat a great deal of the 
rank flavor of the carnivora is avoided." The bill of fare of diabetics 
includes all varieties of fish, shell-fish and lobsters, eggs, cream, and cheese 
of all kinds, spinach, endive, lettuce, sorrel, asparagus, cauliflower, mush- 
rooms, truffles, artichokes, oyster plant or salsify, French beans, cabbage, 
pickles, beet-tops, and tomatoes. Salads may be made of lettuce, celery, 
cucumber, watercress, romaine, dandelion, Brussels sprouts, chicory, young 
onions, cold slaw and olives, with a full allowance of oil and hard-boiled 
eggs. Of fruits are embraced sour apples used moderately, lemons, sour 
oranges, strawberries and currants to be eaten of course without sugar. 
Butter, butter-milk, unsweetened jellies, vinegar, filberts, pecan-nuts, 



316 DISEASES OF THE ABDOMINAL ORGANS. 

aim s, emitts and walnuts. Brazil-nuts and cocoanuts are included. 
-mange made with cream and not with milk, and custards made 
sugar, are allowed. Diabetics may drink c u and c 

- _ . - la- . " sherry, claret, dry Sauterne, 

hock, and in m [iiantities whiskey, brandy, gin, and Burgui 

A >rding to Chambers, fresh beef-tea is a capital quencher of thirst. 
K amiss, if old and free from sugar, is allowable. Glycerine in small 
quantities may be used in lien of sugar in tea and coffee. 

stion of bread is of great importance, as to nearly all pei 
it is quite indispensable. M. Bonchardat devised a bread made of gluten. 
- is neither agreeable to the eye nor to the taste, and. being hard and 
firm. bients are content with the substitute. The bread prepared by 

Pavy is decidedly more palatable. It is made of sweet almonds, which 
are m-st reduced to a fin ir, and then treated with boiling v. 

slightly acidulated with tartaric acid, which deprives them of six per cent 
: sugar. Of the paste thus obtained biscuits are made. Dr. Flint com- 
mends, as m s s ictory than anything which he has before tried, the 
glutt-n bread prepared by the Health Food Company, of New York. It is 
not entirely deprived of starch, but it is so prepared that it retains many 
of the agreeable qualities of ordinary bread, and helps render the animal 
: the daily dietary more acceptable. 

following, epitomized, are among the precepts of Bouchard: 
diabetic patients : — 

Eat slowly and moderately, chewing your food thoroughly. 

As long as the quantity of urine of twenty-four hours is above a litre 
and a half (about three pints), drink as little as possible. 

A minimum of liquid food, such as broth, soup, consomme. 

Sip your liquids, rather than drink; small quantities should always be 
the rule. The sense of thirst can often be assuaged by rinsing the mouth 
with ice-water, or by chewing a little roasted coffee or chocolate nuts. 

Two meals a day; one at 10 a.al. the other at 6 p.m. Instead of taking 
a nap after meals, take a short walk in the open air. 

D not go to bed until at least four hours after the last meal. 

A stain from tobacco as far as possible. 

hygiene of diabetic patients does not consist exclusively in atten- 
tion to diet: it is necessary, also, to indulge in much gentle exercise in the 
open air. All measures which tend to re-invigorate the system ought to be 
employed, and it would be well to vary the exercise according to the needs 
of the patient. Mental relaxation and recreation are essential in all cas s. 
Bonchardat has also insisted on the necessity of especial attention to the 
functions of the skin. In grave cases of diabetes, it becomes dry and 
_h : hence warm baths, followed by friction, are useful, and maybe 
taken two or three times a week. 



DIABETES INSIPIDUS. 317 

Under the treatment advised in the foregoing, in mild cases the sugar 

will absolutely disappear from the urine. In diabetes of medium intensity, 
great improvement may be anticipated, but medicinal measures will also 
be needed. Alkaline waters with the meals are of especial value, and there 
are none better than the Vichy waters. A large number of drugs have 
been recommended in this disease. Their successful employment depends 
upon a judicious application and discrimination; in all cases where an 
agent is being given, frequent analyses of the urine are imperative. 



DIABETES INSIPIDUS. 

Diabetes insipidus, or polyuria, is characterized by a flow of urine 
which in quantity greatly exceeds that in health. In this affection the 
urine is free from sugar, and herein lies the distinctive difference between 
it and diabetes mellitus. A temporary increase of the urine is a symptom 
occurring in various diseases; it is not infrequent in certain chronic affec- 
tions of the kidney. It is also an occasional symptom in diseases of the 
brain and injuries of the skull, and in hysteria, asthma, and other nervous 
affections. The flow of urine may also be increased by excessive drinking 
of fluids, by the use of certain medicinal agents called diuretics, and it 
results from impairment of the skin, as by a chill. It is also noticed in 
convalescence from febrile diseases. In none of these instances can the 
term diabetes insipidus be used, as, when properly applied, it is limited to 
an individual affection characterized by a morbid increase of the urinary 
excretion, occurring independently of any of the foregoing conditions. 

In diabetes insipidus, the daily quantity of urine varies from thirty 
to sixty pints. It is clear, very faintly acid, and of a greenish, opalescent 
hue. It contains no sugar, or other abnormal ingredients. Thirst is in 
direct proportion to the excretion of urine, rising with the increase of the 
latter, until it becomes so intense that the sufferers who have had all fluids 
withheld from them have, in their despair, been known to drink even their 
own urine. The appetite and digestion, as a ride, remain good ; the gen- 
eral health is usually but slightly affected, if the patients are allowed to 
drink freely. One prominent symptom of the disease is an increased flow 
of saliva. 

In some instances, diabetes insipidus comes on insidiously, without 
being preceded by notable symptoms. In a certain proportion of cases, 
there pre-exist headache and other mental disturbances of mild degree. 
The disease has been known to immediately follow wounds of the head, 
violent emotions, and great excess in eating and drinking. The course and 
duration are variable. If it exists independently of recognizable organic 
disease, its duration may be unlimited ; while on the other hand, when 
dependent upon structural changes, such as sometimes follow severe 
injuries to the head, its course may be rapid, and its duration short. An 



318 DISEASES OF THE ABDOMINAL ORGANS. 

hereditary influence is involved in some eases, and patients so predisposed 
not infrequently live for many years. Recovery from diabetes insipidus is 
very rare, but death from it is still more rare. In some cases the disease is 
intermittent ; temporary diminution and subsequent increase of the flow 
of urine and of the thirst have been noticed, and, according to Senator, 
some authors have observed a complete disappearance of both of these 
symptoms, for a longer or shorter time, but without any permanent cure. 

Flint states that, in the majority of instances, the disease cannot be 
traced to any adequate causes. It occurs not infrequently in infancy. In 
a proportion of about one-half, when the disease is developed patients are 
under twenty years of age, and in about the same proportion the age is 
between thirty and fifty. It is extremely rare after the age of fifty. The 
number of males affected with the disease is considerably larger than that 
of females. 

In the treatment of diabetes insipidus, hygienic measures are of great 
importance. Exercise should be taken regularly, and sponge-baths em- 
ployed every morning. At all times the body should be warmly clothed, 
and chilliness of the surface avoided. Nutritious and easily digestible 
food is demanded, and tonic remedies should be administered, if their use 
is indicated. Nothing can be gained by limiting the quantity of fluids. 
Dr. Henry Kennedy, of London, reports five cases, all substantially cured 
by dilute nitric acid. He commenced with one drachm, in a quart of 
water; this amount was taken in divided doses daily. In some instances, 
he increased the acid to the daily amount of four drachms. In every case 
he was successful with this treatment. Other remedies have been used 
with success, among them ergot and gallic acid. 



SECTION VI. 
DISEASES OF THE NERVOUS SYSTEM. 



CHAPTER I. 
APOPLEXY. 



The term apoplexy, signifying a sudden stroke, or shock, is confined to 
a somewhat uniform combination of symptoms, induced by a variety of 
causes. It does not represent an individual disease, but is applied to 
sudden lethargy or profound stupor, occurring in different affections of the 
brain or its membranous coverings. 

The most frequent cause of this condition is the effusion of blood into 
the substance of the brain, producing upon the same a shock, or stunning 
effect, proportionate to the rapidity or the amount of hemorrhage. The 
pressure impedes the circulation in this important organ, and paralysis is a 
common consequence. The hemorrhage depends upon conditions pertain- 
ing to the blood-vessels within the brain. The walls of the arteries either 
become weakened by degenerative changes, or they are subjected to 
unusual and sudden increase in blood-pressure, which induces rupture. 
Doubtless, in many cases, both conditions exist, the latter being frequently 
referable to disease of the heart. There are other causes, however, which 
increase arterial tension, and cerebral hemorrhage has been known to follow 
great mental excitement, as in public speaking, or in a fit of anger. Cases 
have been reported in which straining at stool, violent muscular exercise, 
the throes of labor, and drunkenness, have appeared to produce attacks. 
Generally the hemorrhage takes place without any obvious exciting cause ; 
it seldom occurs in persons under forty years of age. As has been said, 
formerly much importance was attributed to a so-called apoplectic constitu- 
tion, consisting of shortness of the neck, with considerable embonpoint, 
and what is known as a full habit. An analysis of a considerable number 
of cases shows that no reliance is to be placed in these or any other exter- 
nal characters, as denoting a predisposition to cerebral hemorrhage. 

An apoplectic seizure is sometimes the result of hemorrhage occurring 
betfween the brain-substance and the membranes which envelop it. In this 
situation, it may be due to severe blows on the head ; usually, in such cases, 

319 



320 DISEASES OF THE NERVOUS SYSTEM. 

but not in all, there is fracture of the skull. One cause of the so-called 
meningeal hemorrhage is the rupture of aneurisms of the arteries at the 
base of the brain. It also occurs in infectious diseases, in which the integ- 
rity of the blood is destroyed. This form of hemorrhage has been known 
to follow a paroxysm of whooping-cough, to occur during Bright's disease, 
and, rarely, under other conditions, when no especial cause could be deter- 
mined. 

Among the conditions which may give rise to apoplexy is an interruption 
in the circulation of blood in a portion of the brain, by the sudden closure 
of an important artery. This accident is caused by a clot, called an 
embolus, which, forming either in the heart or arteries, becomes detached 
from the walls, and, entering circulation, is swept along with the current, 
until, lodged in an artery of the brain, it plugs the same and cuts off the 
blood-supply. The so-called congestive apoplexy is the result of rapidly 
induced active congestion of great intensity. This condition is common, 
but not constant, in cases of sunstroke. Softening of the brain, if it take 
place rapidly, may give rise to apoplectic symptoms. Aside from those 
already mentioned, other morbid conditions of the brain may exist, and 
other influences which invite there an unusual accumulation of blood may 
co-operate, and cause the affection under consideration. The writer recalls 
a case of unusual interest which occurred in his practice — that of a 
laborer, previously, to all appearance, in perfect health. This man was 
for several hours exposed to a cold rainstorm, and reached home chilled 
and shivering. After sitting before a hot kitchen-fire for a short time, he 
bent forward, with head downward, to unlace his shoes; and remaining but 
a moment in that position, he fell forward unconscious, became at once 
deeply comatose, and died in about an hour. 

Preceding an apoplectic seizure there may be warning symptoms, 
such as vertigo, dizziness, double vision, temporary blindness, flushing or 
pallor of the face, etc. In many cases, however, none of these signs are 
present, and the attack occurs suddenly ; the patient, stricken down as by 
a blow, becomes at once completely unconscious, or rapidly passes into a 
state of coma. During this state of profound stupor, the respirations are 
deep, slow, and noisy, each expiration ending in a puffing sound. The face 
is sometimes pale, but more often it is red and swollen, and after a time 
assumes a dusky, livid hue. The pulse is usually slow, irregular, full, and 
hard; exceptionally, it is small and feeble. During the first few hours, 
the surface is in most cases warm; if the coma lasts for two or three days, 
generally on the second the temperature falls two or three degrees below the 
normal. The pupils of the eyes may be contracted or dilated ; inequality in 
them is of much more serious import than equal dilatation or contraction. 

In some cases it is impossible to arouse the patient in any degree, all 
other movements but those of respiration being suspended ; in a certain 
proportion, however, there is not this total loss of mental faculties. 



APOPLEXY. 321 

Usually the contents of the bowels pass involuntarily ; vomiting is frequent, 
at or shortly after the attack. Paralysis is a common attendant upon 
apoplexy. It is, generally, at first complete, and the affected limbs may be 
devoid both of sensation and motion. In the majority of cases, the former 
is regained after a short time. Generally, the loss of power is limited to 
one side, the paralysis usually involving the muscles of the face on the 
corresponding side. Exceptionally, however, the limbs on one side and the 
face on the opposite side are affected. When the facial muscles are para- 
lyzed, the expression is lost, and the features are often distorted; in speak- 
ing or smiling, the mouth is drawn to the unaffected side. 

Apoplectic coma may last for a few moments only ; it may continue for 
several hours, or even for days, and then pass off. Consciousness usually 
returns slowly ; the patient appears as if awakened from sleep. After a 
time, usually from two to four days, there are, in many cases, headache, 
restlessness, and possibly delirium. As recovery takes place, the facial 
paralysis gradually disappears, and generally the leg gains strength before 
the arm shows signs of improvement. 

The prognosis in apoplexy is always grave ; the greater the age, the 
more unfavorable it is. It may prove fatal, even within a few moments; 
so, too, the attaek may as quiekly pass off, and consciousness return. If no 
improvement in the symptoms takes place within ten or twelve hours, death 
will probably result in a short time, although life may be prolonged for 
several days. The occurrence of one apoplectic seizure, due to hemorrhage 
within the brain, involves liability to recurrence. Of those who recover 
from a first, a considerable portion experience a second attack, after intervals 
of varying duration in different cases. It is a popular prejudice that those 
persons who recover from a second invariably die when a third attack 
occurs. In exceptional cases, only one seizure is experienced, and patients 
have been known to live twenty years, or longer, without experiencing a 
similar accident. 

When an apoplectic attack has occurred, the first step is to send for a 
physician, and until he comes the following treatment is to be employed : 
The clothing about the patient's neck should be loosened, and his head 
moderately raised. As quickly as possible he should be put to bed, in a 
cool, airy apartment, with cold applied to the head and heat to the lower 
extremities, the object being to withdraw, as much as possible, the blood 
from the former. If the shock occurs soon after a hearty meal, and the 
patient can swallow, vomiting must be induced by mustard and water, or a 
dose of ipecac; as soon as possible, a purge ought also to be administered. 
The position of the patient should be on his side, as in profound coma the 
tongue falls back, and interferes with respiration. The physician will, of 
course, determine whether bleeding is necessary. When it is not employed, 
mustard poultices may be applied to the nape of the neck, calves of the 
legs, and over the stomach. The contents of the bladder are almost 



322 DISEASES OF THE NERVOUS SYSTEM. 

always retained after an apoplectic attack, and must be drawn with a 
catheter. Absolute quiet is to be insisted upon, and this fact should 
be remembered, that in such attacks there is danger of doing too much 
rather than too little; the chances of the patient are measured by the 
extent of the injury which induced the shock, also by his re-active 
capability. Aside from the emetic and purge already advised, no other 
medicine will be needed during the first few days following the seizure. 
As consciousness is restored, the vital powers must be sustained by milk, 
beef-juice, beef-tea, etc. In very feeble patients, stimulants will be needed, 
but the responsibility of giving them should rest with the attendant phy- 
sician. When the stage of restlessness has been entered, then narcotics, if 
indicated, may be administered ; a teaspoonf ul of paregoric will often 
suffice to promote sleep. To the paralyzed limbs no efforts should be 
directed, other than gentle rubbing and frequent passive movements, while 
the symptoms denote inflammation or irritation of the brain. After two 
or three months, if paralysis then exists, massage, electricity, rubbing with 
stimulating liniments, etc., may be employed. 

SUNSTROKE. 

The terms insolation and sunstroke are applied tD an affection occurring 
in persDns exposed to extreme heat, under unfavorable circumstances. 
That is, it is not occasioned exclusively by intense heat from the direct 
rays of the sun, but other causes are generally combined to produce the 
result, such as exhaustion from either mental or physical labor. Loomis 
says: " Workmen, soldiers on the march, stokers, and cab-drivers, or brain- 
workers, and those who are suffering anxiety or mental distress, are more 
liable to be overcome by the heat. Hot, wet, muggy days — our August 
dog-days — are the most favorable for its occurrence. Acclimatization has 
Aery much to do with its development. Nearly all new arrivals in India 
at first suffer more or less severely from the heat. Nevertheless, when a 
certain temperature of the air is reached, all alike succumb. Dry, hot 
winds are not prejudicial. In Dakota, men can work all lay exposed to 
the sun, when the temperature of the air is at least 140° to 160° Fahr. ; 
while in New York, on a cloudy, wet day in August, with the temperature 
at only 93° Fahr,, large numbers of men and animals are prostrated. The 
vigorous, thin, healthy individual, who leads a temperate and regular life, 
sel< loin suffers from the heat ; while those who drink freely of alcoholic bev- 
erages, and dissipate during the summer months, are those that most com- 
monly suffer. Large numbers arc affected just after eating a hearty meal." 

Dr. Swift, in a report based on the observation of sixty cases in the 
New York Hospital, gives the following account of the attack: "The 
patients are suddenly seized, while in the performance of their labors, with 
pain in the head, and a sense of fulness and oppression in the pit of the 



SUNSTROKE. 323 

stomach; occasionally nausea and vomiting, dimness of vision, and insensi- 
bility. Surrounding objects appear of a uniform color. In a great majority 
of cases, this was, so far as could be ascertained, blue or purple. In one 
instance everything appeared red; in another, green; and in another, 
white." The attack generally occurs during that portion of the day when 
the heat is of the greatest intensity. It may consist of only a momentary 
insensibility, the patient evidently fainting; but in severe cases, he quickly 
passes into a state of profound stupor. In the latter, the temperature of 
the body is notably raised, the skin is burning to the touch, and either dry 
or moist. The pulse is usually at first slow and full, but becomes rapid 
and feeble toward the fatal termination. The respirations, more often 
increased in frequency, are noisy, being accompanied with snoring sounds, 
sighing, or moaning. Muscular spasm and convulsions are of frequent 
occurrence. Vomiting is a common symptom, and, as the end approaches, 
there are involuntary evacuations from the bowels. 

The chances of recovery depend not only on the intensity of the attack, 
but upon the promptitude with which treatment is applied. On one occa- 
sion, while in Paris, the writer had an excellent opportunity of studying 
sunstroke from the earliest symptom. His fellow-tourist and patient was a 
physician, who minutely described the different sensations as they were 
experienced by him, to the very beginning of the unconscious state. In 
this instance immediate treatment proved successful, and, had it been 
delayed, death would inevitably have resulted. Authorities state that, 
except in mild cases, in which there is transient stupor or insensibility, 
nearly one-half die, the average duration in fatal cases being four hours. 
Doubtless in many of these recorded, treatment was delayed, for the 
experience of the writer sustains the belief that promptitude is rewarded 
by success in a much larger per cent of even desperate cases. In 1871, 
while attached to the largest hospital in New England, some seventeen 
patients were received in a deeply comatose state, nearly all presenting the 
most severe symptoms of sunstroke. If he remembers rightly, but two 
among them died. Of this number, however, the cases of death were 
unusually few, and cannot be accepted as an average rate of mortality. 
Probably, under all circumstances, when the attack is severe, thirty per 
cent die. There are a number of affections which, in some instances, follow 
in the footsteps of sunstroke ; among them may be mentioned epilepsy, 
insanity, loss of memory and of vision, constant headache, and a low type 
of inflammation of the membranes which envelop the brain. Nearly all 
who recover are ever after intolerant of heat, and many are notably irrita- 
ble and easily excited. 

In the management of cases of sunstroke, it is important to remember 
that patients suffering from severe attacks sink very rapidly ; therefore no 
time should be lost in applying at least the first measures of treatment. 
Complete rest is of the utmost importance, and, unless the distance is 



M'4 DISEASES OF THE NERVOUS SYSTEM. 

exceedingly short, the removal of the sufferers to their homes or to hospitals 
is attended with great risk, as it may contribute in no small degree to a 
fatal result. To apply cold to the head is the first measure to be employed. 
Ice, it at hand, should be used : if not, a stream of cold water may be 
poured over the head, back, ami neck. If the heat of the body is very 
great, the patient should be immersed in a bath for a considerable time, 
the water being at first slightly warmed, and then gradually but quickly 
cooled. If there are no conveniences for bathing, then the body may be 
freely and persistently sponged with cold water; or the patient can be laid 
on the floor, covered with a sheet, and with a sprinkling-pot the cold 
water may be applied. This douching can be kept up, at intervals of a 
few minutes, until the heat of the body is notably lessened. If the pulse 
grows rapid and feeble, then stimulants will be demanded. If the patient 
is able to swallow, teaspoonful doses of the aromatic spirit of ammonia, 
well diluted, may be given every half-hour or hour, as the need is apparent. 
If remedies cannot be administered by the mouth, brandy by injection is 
indicated. 

In cases where symptoms of congestion of the brain predominated, the 
writer has bound the extremities, with notably good results. The object 
of this procedure is to temporarily withdraw a quantity of blood from the 
circulation, and to so govern the same it can at once be restored, if signs 
of failure of the vital powers are manifested. At the upper part of the 
thighs a strong cord or bandage can be tied : it should be tight enough to 
prevent the return of the blood to the body from the veins, and yet allow 
it to enter the limbs through the arteries. The ligatured limb soon becomes 
swollen, and thus a large quantity of blood is taken from the circulation, 
and the congestion of the brain is relieved. It has infinite advantages 
over bleeding, as not infrequently, in that operation, too much blood is 
taken, none of which can be restored. In all desperate cases there is liable 
to come a crisis when the patient will need what he has lost, to assist in 
re-action, and death may occur in consequence of the deprivation. 

The use of purgatives is indicated in certain cases, but in those which 
are characterized by a rapid, feeble pulse, and other signs of exhaustion, 
they should be withheld. Convulsions occasionally occur, and the recog- 
nized treatment for them is the inhalation of ether. Rarely will this neent 
be needed, and its use cannot be endorsed, as death almost invariably 
results. A judicious application of cold will, in nearly all, if not in all. cases, 
control the spasms. After consciousness is restored, perfect quiet should 
still be enjoined, and restlessness may be combated with the bromide of 
potassium, in twenty-grain doses. Patients who recover seemingly do so 
quickly, but, after severe attacks, for a long time they are incapacitated 
from mental or physical labors. When possible, they should remove to a 
cool climate, and there, freed from business cares, they should remain until 
perfect health is restored. 



NEURASTHENIA, OR NERVOUS DEBILITY. 325 

NEURASTHENIA. 

The term neurasthenia is used to denote a morbid condition charac- 
terized by weakness, prostration, or exhaustion, affecting especially the 
nervous system, and commonly known as nervous debility. It occurs inde- 
pendently of organic disease, and without any notable disorder of the 
vital functions. Men are far more liable to this condition than women, 
and in adult and middle life it is the most common. 

Among the causes which induce neurasthenia are included all per- 
nicious habits and violations of Nature's laws. As has been said, an inquiry 
into the habits and circumstances connected with the daily life, in the 
cases now referred to, will show that the mind has for a long time been 
unduly taxed by the cares and responsibilities of business, over-exertion in 
the pursuit of wealth or other objects of ambition, long-continued anxiety 
or inquietude, — in short, the patient is suffering from wear and tear of the 
nervous system. The action of mental causes is increased by other causes, 
which tend to diminish the vigor of the body, such as irregular habits with 
respect to diet, the hours devoted to sleep and rest, etc. The causes which 
act directly through the mind are especially operative in this country, 
owing to the early age at which persons engage in the active pursuits of 
life, the great inducement to excessive exertions, and the emulation excited 
by the activity of others. 

Patients suffering from nervous debility are usually depressed, irri- 
table, or morose; they are weak, and fatigued by even slight muscular 
exertion. Aching of the limbs, pains in the back, and wakefulness, are 
frequent sources of complaint. All the vital functions share in the 
debility ; dyspepsia is a frequent accompaniment. Under excitement, 
or after the use of alcoholic stimulants, patients for a brief interval 
are re-animated, and energy is renewed, but prostration soon follows. 
Their apprehensions are easily excited, and they are inclined to fancy 
the existence of some grave organic disease. Persistent neurasthenia 
tends to eventuate in melancholia, hypochondriasis, or other forms of 
mental derangement. 

■ The indications of treatment are to obviate the causes which induced 
the condition. It is desirable to secure for a time absolute rest, and by 
change of scene to draw the mind from all care and vexations. Kelaxa- 
tion and amusement, out-of-door life, sea-bathing, a nutritious diet, and 
sufficient sleep, tend to restore the integrity both of the mind and body. 
Light wine or beer, with the meals, frequently assists recovery ; if a tonic 
is needed, the syrup of the hypophosphites, or some preparation containing 
iron, quinia, and strychnia, is advised. After a season of rest and recrea- 
tion, if the tone of the nervous system is renewed, patients may return 
to their usual labors, never to their old manner of living, for permanent 
recovery is secured only by compliance with the laws of health. 



326 DISEASES OF THE NERVOUS SYSTEM. 



VERTIGO. 

Vertigo, giddiness, dizziness, or swimming of the bead, are synony- 
mous, and expressive of a condition which occurs as a symptom in various 
diseases of the brain, and which also exists as an individual functional 
affection. Attacks of vertigo are ascribed to a great variety of causes, 
among them certain abnormal conditions of the ears, stomach and liver 
disorders, debility and diseases of the nervous system, gout, interrupted 
circulation in the brain, and chronic malarial infection. 

It occurs as a paroxysmal affection. It may be of but momentary 
duration, and it may continue for hours and even days. Objects appear 
to be moving around the patient, or he seems moving around the objects, 
which remain stationary. He reels like a drunken man, and finds it dif- 
ficult to maintain an erect posture without support. Sometimes he falls, 
but there is no loss of consciousness. The attack is frequently attended 
with nausea, and occasionally with vomiting. When caused by affections 
of the ear, deafness in one or both ears sometimes occurs ; when vertigo 
proceeds from gastric derangements, the characteristic symptoms are 
always present. With the so-called nervous vertigo there is irritability, 
restlessness, wakefulness, and other evidences of nervous debility. This 
form of the affection is often an accompaniment of sick headaches. 

Severe attacks of vertigo usually give rise to grave apprehension, and 
true melancholia may ensue, induced by the fears of apoplexy, paralysis, 
or some other serious disease of the brain. Patients may feel assured 
that vertigo is not a dangerous affection, and it has absolutely no ten- 
dency to eventuate in, or be followed by, the diseases mentioned. 

Fortunately it is possible, in the majority of cases, to determine the 
cause, and, when that is apparent, efforts must be made to remove it. The 
ears and eyes should be carefully examined, and treatment instituted if 
any abnormal condition exists. Pernicious habits are to be corrected, and 
intercurrent affections call for appropriate treatment. As a general rule, 
tonic remedies are indicated, and should be employed with hygienic and 
dietetic measures to re-invigorate the general health. 






CHAPTER II. 

EPILEPSY. 

Epilepsy is a chronic functional disease of the nervous centres mani- 
festing itself in paroxysms, which are characterized by temporary loss of 
consciousness and convulsive movements. Convulsions resembling those 
of the affection under consideration occur as symptoms of different affec- 
tions of the brain, injuries of the head, diseases of the kidneys, profuse 
hemorrhages, and a variety of other abnormal states of the system ; they 
may also be caused by certain poisonous agents, for example strychnia. 
These are to be distinguished as epileptiform convulsions, for epilepsy as 
one of the neuroses is a functional affection ; that is, it is not necessarily 
connected with any appreciable change in structure. The fully developed 
form of the disease, in which the paroxysms make their appearance with 
profound insensibility and general convulsions, has received the name 
epilepsia gravior or le /taut mal. The mild and incomplete form, in which 
paroxysmal loss of consciousness alone occurs, the spasmodic element 
being slight or entirely absent, is called epilepsia mitior, le petit mal, or 
epileptic vertigo. 

That epilepsy is hereditary is now universally accepted. In fact, any 
nervous disease in the parents, whether it be of a lighter or more serious 
nature, may plant in the children the germ which may develop into 
epilepsy. As, for instance, epileptic children have been born to parents 
long sufferers from hysteria, hypochondria, catalepsy, "sick headaches," 
neuralgias, and otheri mpaired nerve-states. There is reason to believe 
that ancestors given to the intemperate use of alcohol transmit to their 
offspring a tendency to epilepsy. One author says : " Age is of considera- 
ble weight in the causation. In a small proportion of cases the disease 
either exists from birth or is developed in infancy. In nearly one-third of 
the cases it dates from two to ten years of age, and in a somewhat larger 
proportion from ten to twenty years. The number of cases in which the 
development is between twenty and thirty years is much less, and at a later 
period of life the number is comparatively small. In the great majority 
of cases, at the commencement of the disease the age is between two and 
twenty years." 

327 



DISEASES OF THE NERVOUS SYSTEM. 

Very many causes have been assumed as capable of producing epilepsy, 
which cannot be sustained by comprehensive statistics. Among the 

number are sexual excesses, close and continuous mental exertion, and 
general disturbances of nutrition. While their causative influence is at 
least not proved, still the possibility that it exists cannot be wholly 
:ted. External traumatic agencies acting upon certain nerves or their 
branches, and less often the pressure of tumors on the same, have with 
evident propriety been assumed as a cause of epilepsy. It has been sug- 
sted that in some cases a connection exists between epileptiform con- 
vulsions occurring at the teething period, and the subsequent epilepsy. 
The disease also sometimes follows, as a secondary consequence, injuries of 
the skull and corresponding affections of the brain substance. In such 
cases the brain is often wounded by splinters of bone. The psychical 
impressions, fright, grief, anger, painful excitements, and joy, play impor- 
tant parts in the causation of epilepsy. Through terror, the sight of a 
person suffering from a seizure has been known to excite the same in 
others. Among other influences which may justly be considered as capa- 
ble of inducing the outbreak of this malady are, overloading the stomach 
with food, intoxication, intense suffering, over-exertion, and great fatigue. 
Certain morbid states, such as those existing during the course of, or con- 
valescence from fevers, and those which may be present at commencing 
womanhood, have been known to provoke the first seizure. Joseph Frank 
brings forward over a hundred causes which have excited this disease, or, 
as he says, "at least single seizures of it." Doubtless, in many instances, 
the evidence is insufficient to sustain the assumption that causative influ- 
ences exist. 

Epileptic seizures may either occur with extreme suddenness, or be 
preceded by warning symptoms. These signs which foretell a coming 
attack have long been divided into the remote and the immediate. The 
former, comparatively rare, may be manifested from two to four days 
before a paroxysm takes place. The remote warnings include changes in 
disposition, such as nervous excitement, talkativeness, moroseness. irrita- 
bility, petulance, and distrust. Dizziness, headache, and confusion of the 
head, are, in some eases, added to these symptoms: in others they form 
the only prodromes. The remote warnings come more often to patients 
who have remained free from an attack for a considerable length of time. 
Although confidently expected, a seizure does not, however, invariably 
follow them. There are a variety of symptoms other than those described 
which may be included among the early signs. As for instance certain 
patients feel a leaden weight in the limbs, or slight trembling for several 
days before a paroxysm. Xothnagel tells of a lady who was able to pre- 
dict a seizure with certainty by more profound sleep the night previous, 
and Reynold mentions that he has sometimes seen a peculiar dark discolor- 
ation of the skin, especially in the face and neck, as much as twelve hours 
before a convulsion. 



EPILEPSY. 329 

The immediate warning of an approaching fit occurs only in a limited 
number of cases; it is then more often a sensation which the patient is 
unable to describe, and has individual peculiarities. The aura epileptiea 
first described by Galen is a sense of a "cold vapor" emanating from 
some part of the body and mounting to the head. Some epileptics expe- 
rience dragging, tearing pains over a whole extremity, others are affected 
with general or one-sided headache, wdiile there are yet others who suffer 
from great distress in the pit of the stomach. Occasionally are found 
patients in whom there is decrease in sensation in one extremity, or one 
half of the face, those affected complaining of a feeling of numbness, 
generally beginning in the fingers or toes of the affected side. Since 
in individuals who experience the immediate warning, which, on an aver- 
age, lasts from half a minute to five minutes, there is some distinctive 
manifestation peculiar to each, no extended description will be attempted. 

When an epileptic seizure occurs, consciousness is in some cases at once 
completely lost, and a general convulsion immediately follows, or is 
declared at the same moment. This form of an attack comes so quickly, 
the patient falls as if struck by lightning. In occasional instances, the 
loss of consciousness is more gradual, an interval of a few seconds being: 
allowed. Generally, however, there is a sudden arrest of all mental 
activity ; the patient falls to the ground, after uttering a cry, as Romberg 
expresses it, "shrill and terrifying to man and beast." At the time of the 
seizure the face is extremely pale, and the eyes are fixed and staring. The 
convulsive movements at once commence; at first there is a forcible con- 
traction, which persists for several seconds. The muscles then present 
contractions and relaxations in rapid succession, inducing the most violent 
contortions. The face, hideously distorted, soon becomes dark, and its 
blood-vessels swollen ; the eyes protrude, and the pupils are alternately 
dilated and contracted. The tongue is sometimes thrust between the 
teeth, and the edges deeply lacerated. Respiration is noisy, forcible, and 
quickened ; sometimes it is spasmodically interrupted. The sufferer froths 
at the mouth, and the saliva is often bloody. The body is bathed in a pro- 
fuse perspiration ; there is a rumbling in the bowels, and the contents of 
the intestines and bladder are expelled with considerable force. 

The paroxysms generally terminate gradually, the convulsive move- 
ments becoming less rapid and violent, the embarrassment of respiration 
diminishing; finally, there is a deep, long-drawn sigh, and the jerking of 
the limbs ceases. The convulsion generally lasts about a minute ; rarely 
is it of longer duration than three minutes; the patient then passes into a 
state of profound stupor. Consciousness usually returns in a few minutes, 
the patient awaking as if from a deep sleep ; occasionally the comatose 
state is prolonged for half an hour. If a violent attack has been experi- 
enced, the patient feels fatigued, unnerved, and as if bruised all over ; in 
some instances paroxysms are followed by delirium. 



330 DISEASES OF THE NERVOUS SYSTEM. 

Epilepsia mitior, or le petit maL is characterized by a momentary loss of 
consciousness. The period during which mental activity is suspended, in 

the majority of c:i>o. is from a few seconds to half a minute, although 
exceptionally it may continue for from four to eight minutes. Nothnagel 
- ■ - : -As a rule, consciousness is lost without any premonitions ; while 
eating, the patient lets his spoon and knife drop, his look becomes fixed; 
sometimes this lasts only so long as to exeite the attention of those about 
him ; then he resumes eating again. While in the midst of talking, he 
suddenly stops ; after a brief absence of mind he goes on again. While 
walking upon the street he stops still, but need not necessarily fall, if the 
arrest of conseiousness is brief enough. It may happen that the more 
automatic actions are not once interrupted ; the sufferer goes on walking, 
continues to play on the piano, and the like. But, on the other hand, 
when the absent-mindedness is longer, he may fall down, or, if riding, be 
thrown from his horse."' 

Loomis says: -An attack may be masked by such motor activity 
that the patient runs or walks rapidly during a period of complete uncon- 
sciousness. Sometimes maniacal excitement takes the place of the tit. 
In this delirium an epileptic may be harmless, and wander around in 
a dazed condition ; or be exceedingly dangerous to those about him. 
Kleptomania and dipsomania are said to be exhibitions of epileptic delir- 
ium."' There are a great variety of forms, other than those described, 
under which epileptic attacks may exhibit themselves. If they occur in 
the night, the malady may exist for a long time before its existence 
is ascertained. It may be suspected, when a person, from time to time, on 
waking, complains of being tired and exhausted, has headache, pains in 
the limbs and back, his mind is confused and his memory enfeebled. 
With such symptoms, wounds of the tongue would have an especial 
significance. 

The prognosis in cases of epilepsy, as regards immediate danger, is 
always favorable; it rarely directly causes death. That the malady is 
curable is generally conceded : it is also agreed that the percentage of 
cures is a very small one. The disease, with but comparatively few excep- 
tions, becomes confirmed, and the paroxysms recur with increasing fre- 
quency. Inherited epilepsy is rarely recovered from. Reynolds states 
that the more obscure the origin, the worse the outlook. In very isolated 
cases, from four to five in the hundred, the malady disappears sponta- 
neously. 

Active interference is not demanded during an epileptic convulsion, 
excepting to prevent the patient from injuring himself. Aside from this, 
to loosen the clothing about the neck and chest is about all that can be 
d ■>•'.('. It is seldom possible to prevent the biting of the tongue, and after 
the attack has commenced no effort should be made to keep the jaws 
apart. The measures which have been employed for the cure of epilepsy 



EPILEPSY. 381 

arc innumerable. As one author says: "Small, indeed, is the actual 
encouragement derived from looking through those chapters of medical 
literature, from the oldest to the most recent times, which refer to the 
treatment of epilepsy. The methods and the remedies change ; but the 
final result always remains the same beggarly one." 

It is important in treatment to obviate the cause, if possible, or render 
it inoperative. Measures are to be directed to the removal of all abnormal 
states, such as anaemia, plethora, disturbances of digestion, etc. All 
improper habits must be corrected ; mental excitement and physical 
excess should be avoided. Intemperance in the use of food, as well as 
over-indulgence in stimulants, are expressly forbidden. In fact, the laws 
of health are to be religiously observed. 

Of all remedial agents the bromides have proved the most serviceable 
in the treatment of epileps} r . A small number of cases have been cured 
by them, and a very large number have experienced a more or less marked 
improvement from their use. Rarely have they failed to make the seizures 
less frequent, and, where they have previously been frequent, patients 
have passed several months, and even longer, without a paroxysm. In the 
practice of the writer the following preparation, as advised by Brown- 
Sequard, has proved of extraordinary value : — 

T£ Potass, iodidi 3 j. 

Potass, bromidi ^ J- 

Ammon. bromidi 3 ij ss. 

Potass, bicarb . S ij. 

Infus. columbse ^ vj. 

Ft. mist. Sig. : Dose, as directed. 

Of this one teaspoonful should be taken three times daily, before each 
meal, and three teaspoonfuls at bedtime, in a little water. It should be 
remembered that it is never safe for a patient taking this medicine, and 
receiving benefit therefrom, to be even one day without it, so long as he 
has not been at least fifteen or sixteen months quite free from attacks. If, 
under this treatment, there are present evidences of debility, or if the 
paroxysms still recur, the following is recommended : — 

J2 Zinci oxidi 3 j. 

Ext. cannab. ind gr. iv. 

Ext. glycyrrhiz q.s. 

Ft. pil. No. 20. Sig. : Dose, one. 

One of these pills should be taken three times daily, about an hour 
after each meal. It is to be understood that the mixture previously advised 
and the pills are to be employed at the same time, if necessary, the former 
being taken before the meals, and the latter after eating. During this 
method of treatment, the diet should be nourishing, and limited to sub- 



DISEASES OF THE NERVOUS SYSTEM. 

stances easily digestible. Among the hygienic measures to be employed 

are cold douches or shower-baths, unless their use is specially contra- 
indicated. 

NEURALGIA. 

Neuralgia signifies a functional affection of the sensory nervous appa- 
ratus, the chief and important symptom of which is pain. As there are 
neither inflammatory nor other material changes demonstrable in the 
nerves affected, neuralgia may properly be regarded as merely a symptom 
and not as a distinct disease. As one author states: " There is a conditi 
of morbid sensibility, and this is all that can be said of its essential patho- 
logical character." 

Neuralgia is one of the most common disturbances; in many cases it 
is referable to very definite and well recognized injuries or morbid condi- 
tions, but in as many others the causes are obscure and uncertain. The 
affection is hereditary and may proceed directly from the parents, or if 
the same have suffered from other serious nervous affections such as epi- 
lepsy, insanity, chorea, and chronic alcoholism, then they may transmit 
to their children a constitutional condition which predisposes to neuralgia. 
Among other predisposing causes to this affection, Anstie dwells upon 
what he terms the purely functional influence of educational misdirection 
of intellect and emotion. He states that it is his conviction that next to 
the influence of neurotic inheritance, there is no such frequently powerful 
factor in the construction of the neuralgic habit as mental warp of a cer- 
tain kind, the product of an unwise education. Continuing, he says : " I 
believe that there are certain emotional and spiritual and intellectual 
grooves into which it is only too easy to direct the minds of young 
children, and which conduct them too often to a condition of general 
nervous weakness, and not unfrequently to the special miseries of neu- 
ralgia. As regards the working of the intellect, it is easier to sneak in a 
free and unembarrased manner than respecting the other matters. There 
can be no doubt that, of intellectual, that sort which exhausts and harasses 
the nervous system is the forced, the premature, and the unreal kind ; 
and it is this which predisposes, among other nervous maladies, to neu- 
ralgia. It is more difficult to speak the truth about emotional influences 
generally, and especially about those which are concerned with the highest 

itual matters; but I should do wrong were I to suppress the statement 
of my convictions on this point. I believe that a most unfortunate, a posi- 
tively poisonous influence upon the nervous system, especially in youth, is 
the direct result of efforts, dictated often by the highest motives, to train 
the emotions and aspirations to a high ideal, especially to a high religious 
ideal." 

There are an immense variety of causes which are capable of producing 
neuralgia. Among them are cold, and especially cold wind, overwork of 



NEURALGIA. 333 

the eyes, severe injuries to nerves, compression of them by the growth of 
tumors, or other destructive changes resulting from progressive ulcera- 
tions, lead, mercurial, copper, and other states of chronic blood-poisoning. 
Irritations proceeding from the genito-urinary organs undoubtedly con- 
tribute to its production. It is also induced by decayed teeth, dyspepsia, 
worms, constipation, etc. There are certain skin diseases, among them 
herpes zoster, which are accompanied by this affection. A potent influ- 
ence which assists in its development is that of anaemia and mal-nutrition 
generally; the same may be said of alcoholic excess, and other vices which 
exhaust, debilitate, and impoverish the nervous system. The period of 
life is an influence which must not be underestimated as a predisposing 
cause. Cases are undoubtedly met with in childhood, but it is rare before 
the beginning of adult life ; those between twenty and fifty years of age 
suffer most frequently. Women are more liable to the affection than men, 
but the latter oftener suffer from sciatic neuralgia. 

Before an attack is fully established, for a longer or shorter time there 
may be experienced numbness, slight twitching or prickling sensations in 
the nerve-region about to be affected, but seldom does it occur suddenly 
and rise at once to its full intensity. The pain which characterizes neu- 
ralgia may be boring, tearing, cutting, darting like lightning, or, in rare 
instances, burning. It is at first intermittent; later it becomes continuous, 
with but partial subsidence. The pain shoots along the course of the 
affected nerve, and in the region involved there are several points ex- 
tremely sensitive to pressure. Movements in the parts traversed by the 
nerve are interfered with on account of the increased suffering which 
accompanies them. 

Neuralgic attacks have no fixed duration. In some cases, they cease in 
the course of a few minutes ; in others, they continue for several hours, or 
even days. As the paroxysm draws to an end, the pain rarely disappears 
abruptly, but more often it diminishes gradually. Attacks are seldom, if 
ever, attended with constitutional disturbance. There is no fever, and 
the pulse remains of normal frequency, or is retarded. The return of 
the disease after a certain number of hours or days is not uncommon ; the 
affection is then said to be periodic neuralgia. Recurring attacks often 
take place without any appreciable cause ; generally, however, patients 
learn by experience the conditions capable of inducing them, and these 
they avoid with the greatest solicitude. The disease may become chronic, 
and attacks be experienced at intervals for years, and even for a lifetime. 
In old and protracted cases, the general health, after a time, suffers; the 
blood becomes impoverished, the nervous system debilitated, and the mind 
disordered. 

Romberg has said that "pain is the prayer of a nerve for healthy 
blood." This is exceptionally true in neuralgia, and patients who suffer 
from the disease almost universally require more and better blood. Before 



334 DISEASES OF THE NERVOUS SYSTEM. 

discussing treatment, it is necessary to consider how to discriminate between 
neuralgic and other similar pains. These rules should be borne in mind. 
First, the pain is more often on one side, excepting in very severe cases, 
when it is sometimes felt on both sides. Secondly, it is gusty in char- 
acter: not a steady, continuous pain, but conies in ebbs and flows. 
Thirdly, persistent neuralgia generally occurs in patients suffering from 
physical depression, imperfect nutrition, or exhaustion. It is a very 
common ailment among women, and exhibits itself by pain in the side or 
under the heart. In such cases, it is associated with "weakness" peculiar 
to the sex, prolonged nursing, excessive tea-drinking, or dyspepsia. 

In the management of this disease, for the immediate relief of pain, 
morphine is the most effectual. If the attack is of great severity, this 
agent should, if possible, be administered hypodermically. In the absence 
of a physician, morphine combined with other narcotics can be given by 
the mouth. The so-called " neuralgic pill " of Brown-Sequard, for sale by 
all druggists, is an admirable combination of morphine, belladonna, aconite, 
etc., and the dose is one every six or eight hours until relief is obtained. 
Among the many external applications used to control the pain, satisfac- 
tory results have been secured by a mixture of one part of menthol to 
ten of alcohol. These are the principal ingredients of the most exten- 
sively advertised "pain annihilators." The essential oil of peppermint 
has been much used alone ; it is more efficient when combined with 
chloroform and spirit of camphor in equal parts. Another excellent 
application in neuralgias, in which the pain is confined to a small area, is 
a mixture of iodoform and collodion, sixteen grains of the former to half 
an ounce of the latter. This quantity is usually sufficient for one ordi- 
nary single application. It is most effective when painted on in very 
thick layers, which may be conveniently done with a camei's-hair brush. 
As soon as one coating becomes a little firm, another is applied, and so on 
until the entire mixture is used. In narrowly localized cases, a cure, when 
effected, is usually accomplished with one or two applications. 

After an attack of neuralgia has been arrested, the cause which induced 
it should, if possible, be obviated. Reforms should be. instituted, all per- 
nicious habits corrected, and irregularities overcome; intercurrent affec- 
tions demand appropriate treatment. As has been said, " it is useless 
to attempt to feed up the patient if drains upon the system are left 
unchecked, or sources of nervous exhaustion are permitted to remain. 
Every form of debilitating action, mental and bodily, should be removed." 
After this is done, then iron, arsenic, quinine, and strychnia, are to be 
relied upon. When anasmia exists, the following is a useful prepara- 
tion : — ■ 

J£ Ferri et ammonise citratis ^ ]• 

Sol. Fowleri ^ ij. 

Ft. mist. Sig. : Dose, six drops, after eating. 



NEURALGIA. 335 

This dose should be gradually increased one drop every three days 
until ten are being taken. When there co-exists rheumatic or gouty affec- 
tions, particularly in subacute and chronic cases, the salicylate of quinine, 
in doses of six grains, three times a day, is advised. 

In some cases of neuralgia, the pain recurs at stated intervals, due, 
doubtless, to malarial influences. The sulphate of quinine is then indi- 
cated, in doses of twenty grains, six hours previous to the period when a 
paroxysm is expected. When the blood is poisoned with lead, the iodide 
of potassium, in doses from five to ten grains, should be taken three times 
a day. The influence of fat over neuralgias is unquestionable, and cod- 
liver oil, when it can be borne, should enter into the treatment of all forms. 
If the patient has an unconquerable aversion for this remedy, then fatty 
foods, such as butter, eggs, and cream, should enter largely into the diet. 
Anstie can scarcely sufficiently extol the consumption of even a larger 
supply of food than is necessary for a healthy person. In fact, the diet of 
neuralgic patients should not only be generous, but also consist of the 
most nutritious articles. 

Regarding the mode of life which should be adopted by these patients, 
since its careful regulation must, in all cases, form an essential part of the 
treatment, Erb says : " In the first place, the patient should be most care- 
ful in maintaining both mental and bodily rest; no violent exertions should 
be made, and all mental excitement must be avoided ; if possible, business 
for a time should be entirely given up. In the next place, all means 
should be adopted to give the patient complete rest, and, especially, a 
large amount of sleep; if necessary, this must be obtained by the use of 
medicines ; amongst them chloral, especially in combination with a little 
morphia, is the best. Great regularity in the mode of living must be 
particularly insisted upon ; attention being paid to the due alternation of 
exercise and rest, to regularity in the hours at which the meals are taken, 
and to a certain amount of rest after meals. Moderate exercise in the 
open air in fine weather, or mere exposure to the air in those who are 
very delicate, is very useful." By proper clothing neuralgic patients 
should be carefully protected from sudden climatic changes. It will also 
be well for them to harden the skin by sponging with cold water, friction, 
and cold shower-baths, with subsequent cold douche on the back as a 
very effective means of hardening the constitution. 



CHAPTER III. 
HEADACHE. 

Headache is an extremely common affection, which exhibits itself in 
many and varied forms. It occurs more or less constantly, not only in 
nervous diseases, but in almost every other disease, as in fevers, disturb- 
ances of the digestive organs, affections of the brain and its membranes, 
inflammations in adjoining parts, etc. The influences which are capable of 
inducing pain in the head are almost numberless ; strong mental emotions 
and abnormal conditions of the body are alike influential. 

Some of the forms of headache may be briefly alluded to — volumes 
of space would be necessary to consider all of them. In fevers, whatever 
the exciting causes, headache is one of the most constant symptoms. In 
ordinary cases it is moderate in intensity, dull, and deep-seated, situated, 
as it were, at the base of the skull. It is increased by movements of the 
head, on stooping, and the like, and is accompanied by a feeling of light- 
headedness. The so-called sick headache is sometimes preceded by dis- 
turbances of vision; not infrequently patients complain of seeing variously 
colored lights and scintillations. The pain is almost invariably confined to 
one side of the head, and may be distinctly localized or diffused. Usually, 
there is one small point where it is most intense and persistent. Early in 
the attack the face becomes pale, and the action of the heart slow and 
weak ; the arteries of the neck throb ; the head is hot, and seems bursting. 
Generally within a few hours nausea and vomiting occur, and are sometimes 
attended by recurring chills. The condition of the patient is now charac- 
terized by great depression ; he, in fact, feels wretchedly ill. After a 
longer or shorter time, he falls asleep, and, usually, on waking, the pain is 
less, or entirely absent; soreness of the scalp, and stiffness of the muscles 
of the neck, may linger for several days. 

Sick headache, or migraine, as it is called, is a neuralgia. Sufferers 
from it attribute it to "biliousness," and consider that the nausea and vom- 
iting are proof positive that their trouble is due to derangements of the 
stomach and liver, and that the headache is consequent upon it. One 
author says: "The immediate occasion of an attack may be anything 

336 



HEADACIIK. 337 

which tends to exhaust the system, especially overwork, which wearies the 
body while it taxes and worries the mind, and loss of sleep. Any slight 
deviation from one's usual routine, like a shopping excursion, or late hours, 
loss of a meal, or eating at an unusual hour, will induce an attack in some 
persons. Gastric derangements, like any other, will occasion them, but the 
notion that so-called 'biliousness' is the great cause of sick headache is a 
mistaken one. The trouble commences at the other end of the line, and 
nausea and vomiting are secondary. This does not lessen the importance 
of keeping the digestive system in good order; but, in typical migraine, 
I think exhaustion or loss of sleep is the occasion of ten attacks to one 
where indigestion is the cause. Undigested food is, I think, not usually 
seen in the vomit of migraine." 

The form of headache which is associated with anaemia usually affects 
equally the brow and temples. In character it is dull, not violent, and is 
attended with a feeling of constriction. Congestive headache generally 
affects the whole head ; it is often accompanied by throbbing, and by sen- 
sations of pressure and weight. The face is flushed, the eyes are red- 
dened; the patient is generally very irritable, and at times slightly 
delirious. Under the name toxic headaches, Erb includes those caused by 
the entrance of certain poisons into the system, or by infection with cer- 
tain products and germs. He says the best example of this is found in the 
headache following alcoholic intoxication, which causes, in the morning 
after free libations, a feeling of painful pressure and weight, which appears 
to be chiefly localized at the base of the brain and in the deeper parts of 
the eyes. Headaches are caused by narcotics, lead-poisoning, certain vapors, 
impure air, etc. They also occur in kidney diseases, typhoid fever, and 
malaria. Rheumatism sometimes affects the muscles of the head, and 
gives rise to a severe, tearing pain. One obscure form of the affection is 
denominated sympathetic headache, which is most commonly attendant 
upon disturbance of the stomach and other important organs. Severe 
nervous headaches are characterized by a tearing, boring, throbbing pain. 
Patients sometimes feel as though the head was splitting open, or a red-hot 
nail was being thrust into it. In mild attacks the pain is dull, heavy, 
oppressive, and deep-seated. The latter form is quite a constant symptom 
of neurasthenia, and is caused by severe mental or bodily exertions, loss 
of sleep, distressing emotions, etc. Headache, lastly, is a very important 
symptom of disease of the brain and its coverings ; rarely is it absent in 
all such affections. Often the pain is intense, deep-seated, and of a boring, 
throbbing character. 

Certain forms of headache are prone to recur at intervals; this is 
especially the case with sick headache. Very many persons arc subject to 
this affection ; there exists within them a constitutional predisposition to 
the same. The obvious exciting causes which induce the attacks have 
already been described ; many patients who have suffered from them 



6&Q DISEASES OF THE NERVOUS SYSTEM. 

throughout early and middle life become exempt between the ages of forty 
and fifty years. The existence of obstinate forms of headache, which have 
lasted for years, has an important medico-legal bearing. It is interesting 
to note that in the case of Freeman, the religious fanatic, who sacrificed 
his children, headache was a prominent symptom for years before his 
crime. John Kemble also had severe headaches for years before he killed 
his three children, and experienced many attacks while in prison; subse- 
quently epileptic convulsions came on. Benjamin Eastman suffered from 
obstinate headaches, with tenderness in certain regions of the skull; 
during the paroxysms his intellect was cloudy, though at other times it 
was perfectly clear. Williams, the Somerville murderer, had similar 
symptoms. Lena Daniels the infanticide, was another victim to severe 
headaches, and showed a marked difference in her manner while they 
existed. 

Almost impossible as it is to describe the varied forms of headache, no 
less difficulty is encountered in attempting to define appropriate treatment. 
Individual cases should be carefully studied, and all the concomitant cir- 
cumstances considered. Treatment should be directed to the primary, or 
constitutional, disease, or the abnormal conditions which excite the attacks. 
Thus, if the pain comes on directly after a meal, and it can be traced to 
indigestible articles of food, if the patient is comparatively strong, then 
the following emetic will prove useful : — 

JJ Pulv. ipecac gr. xxv. 

Ammon. carb gr. v. 

Aq. nientli. viridis 3 ij. 

Ft. mist. Sig. : Take at one dose, and follow by a glass of warm water. 

When the pain ensues some hours after taking food, the following for- 
mula is generally beneficial: — 

^ Pulv. rbei 3 j. 

Magnesise carb 3 ij. 

Spt. ammon. arom 3 ij. 

Syr. zingiberis 5 ss. 

Aq. menth. pip ad. ^ U- 

Ft. mist. Sig. : Dose, one tablespoonful, in a glass of hot water. 

If a headache of this character is of constant occurrence, then the 
dyspepsia calls for appropriate and persistent treatment. 

If, in congestive headaches, laxatives are required, the following is 
advised : — 

^ Ext. sennse, fid 3 ij ss. 

Magnesise sulpli ^ ij. 

Acid, sulph. arom 3 ij. 

Syr. aurantii cort ^ j. 

Infus. rbei o ij ss. 

Ft. mist. Sig. : Dose, one tablespoonful, in water, in the morning, on rising. 



HEADACHE. 339 

If congestive headaches are attended with debility, a preparation of 
iron will be demanded. In some cases, temporary relief is afforded by the 
application of a hot salt-bag to the back of the neck. 

In rheumatic headache, mustard poultices to the neck arc exceedingly 
useful, or the following may be employed as an external application : — 

Ji Liniment, cliloroformi .... 

Liniment, belladonnas . . . . aa § 3 ss * 
Tincturae opii 5 J- 

Ft. mist. Sig. : Poison. For external use only. 

Nervous headaches are sometimes controlled by the following : — 

fy Potass, bromid 3 ij. 

Amnion, bromid 3 j- 

Aq. menth. pip § rj- 

Ft. mist. Sig. : Dose, one tea spoonful, every half -hour until relieved. 

The following is a paraphrase of the treatment of sick headaches 
advised in an article which appeared in one of the prominent medical 
journals: Remedies are to be employed, first, to avert an impending 
attack ; second, to put the system into such a condition as to render it less 
liable to one. First, to avert an impending attack, the most efficient rem- 
edies are guarana and caffeine. Thirty grains of the powder, or one tea- 
spoonful of the fluid extract of guarana, or three or four grains of caffeine, 
should be taken every twenty minutes or half an hour, until three doses 
are taken, unless the symptoms sooner show signs of abating. Patients 
can generally foretell an attack, and if this treatment is employed while 
the threatening symptoms exist, it will, in many cases, prove successful. 
After an attack has a] j tared, however, in its full intensity, it may be 
shortened, but will rarely yield to these remedies. Attention to minor 
points may aid in averting an attack. When the patient has undergone 
unusual fatigue or loss of sleep, — anything which his usual experience 
leads him to suspect will be followed by sick headache, — he should take at 
bedtime thirty grains of the bromide of potassium, to lessen his liability to it. 
Under the same circumstances, if the patient is constipated, a laxative 
pill will be needed. If this has been neglected, a dose of the citrate of mag- 
nesia may well be taken in the morning, with the caffeine. In fact, sufferers 
from sick headaches should always correct at once every seemingly trifling 
irregularity, as slight disturbances are often sufficient to turn the scale. 

Of more importance than to repel a single assault is it to so fortify the 
system that none will be made. How to do it must be left to the judg- 
ment of the physician, in view of the needs of each individual case. 
Every drain and tax and irregularity that the patient has learned by 
experience invites an attack must be looked after, and stopped. Loss of 
sleep and irregular hours must be prevented. Over-lactation may be the 



340 DISEASES OF THE NERVOUS SYSTEM. 

trouble with one, abase of tea or coffee, or tobacco, with another; over- 

feeding with some, under-feeding with many more. This latter is not 
infrequent, from a notion that in the stomach or liver lies the root of the 
difficulty. In general, build up the patient's health and strength by what- 
ever means seem most indicated. If anaemic, of course give iron. Gener- 
ally, tonic doses of quinine, or of some of the preparations from Peruvian 
bark, are of as much service as any one drug. Arsenic is highly com- 
mended by some ; one-fiftieth grain doses of the iodide of arsenic, three 
times a day, continue 1 for a considerable period, diminishes the frequency 
and severity of these attacks. If there is the slightest constipation, use 
laxatives, preferably the aloetic, but avoid purging. A full diet is gener- 
ally indicated. The physician or nurse, when doing night-work, should not 
fail to take food in the night. Fasting then makes one doubly liable to an 
attack the next or second day. The use of fat food, cream, and cod-liver 
oil is strongly recommended by Anstie in this as well as neuralgias gener- 
ally. A careful and persevering use of such means will, in a great majority 
of cases, diminish very much the frequency and severity of these attacks. 

In all forms of headache various palliative measures may be resorted to, 
such as lotions to the head of alcohol or other spirits, vinegar, ether, etc. 
In some cases a towel or napkin wrung out in water as hot as can be borne, 
and wound around the head, is more efficient than cold applications. Hot 
foot-baths, strong coffee and tea, and electricity are useful in some cases ; 
menthol is also sometimes serviceable. 

The more common forms of headache, and the appropriate treatment 
which they demand, have been described. It remains to suggest a remedy 
which is likely to prove of service in those attacks which occur without 
obvious causes. The following mixture has been found serviceable : — 

J^ Potass, bromid 3 ij. 

Tr. aconiti rad 3 j- 

Aquae distil 

Syr. simp aa 3 ij. 

Ft. mist. Sig : Dose, a dessertspoonful, in water. 

This is a large dose of the principal ingredients, and should not be 
repeated. 

INSOMNIA. 

Insomnia, or sleeplessness, is one of the most troublesome affections 
which physicians are called upon to treat. Doubtless due to the subtle 
influence of fashion, in this age when health kneels to pleasure, it is now a 
more frequent complaint than in former years. While not in itself a dis- 
ease, but in reality only an effect or symptom in connection with morbid 
conditions, yet its importance entitles it to special consideration, and for 
convenience it is classed with the individual affections. 



INSOMNIA. 341 

The functional activity of the brain is in direct proportion to the blood- 
supply. Sleep is a condition which is produced by a diminution of the 
quantity of blood in the brain, and a decline in the activity of that organ. 
Therefore all influences which interfere with this modification in the vascu- 
lar system, and keep up an active circulation in the brain, tend to prevent 
sleep. Fothergill says: "With many persons sleep is unattainable if their 
feet be cold. This condition, depending upon contraction of the small 
arteries of the lower limbs, is not confined to the extremities of the limbs, 
though, of course, it is most pronounced there. It affects a large portion 
of the vessels of the body, and by thus, as it were, driving the blood to the 
head, keeps up a condition of arterial vascularity in the brain, which effec 
tually prevents sleep. Here the warming of the feet is often sufficient 
to permit of sleep, without any resort to sleep-producing agents. In order 
to warm the feet, many resort to hot bottles; but a much more effectual 
method, especially with young persons, is to immerse their feet in cold 
water for a few moments, and then to rub them well with a rough towel 
until they become warm. If this can be done ere getting into bed, that 
coldness of the feet which is so inimical to sleep will usually be no longer 
felt. 

" Cold is often a cause of insomnia. If insufficiently clad, so that the 
cutaneous vessels are not relaxed, sleep is rarely sound, when attained at 
all. It is only when stupefaction from cold occurs that the dangerous 
coma-sleep comes on, which is so often fatal. With many persons sleep is 
impossible, if the bed be not warmed previous to their entering it. In 
these cases, the contraction of the small arteries, induced by the contact 
with the cold bedclothes, does not pass readily into the opposite condition 
of relaxation, and so sleep does not come on. This state of affairs is very 
commonly met among the aged, the most so in those who suffer from some 
form of heart disease. In such cases it is not only desirable to warm the bed 
and the nightclothes, but also to administer some hot fluid, all the better 
for containing alchohol, when the patient has got into bed, if any sense of 
chilliness remains. In the young and healthy, the chill on getting into 
bed, however, is often of great service in inducing a subsequent relaxation 
of the cutaneous vessels, and thus conducing to more perfect diminution 
of blood in the brain, and sounder sleep. Few persons will have failed to 
note the deep and usually refreshing sleep which follows any disturbance 
during the night, which has exposed them briefly to cold. Getting up to 
do some little service for a sick friend, or to attend to some natural call, 
will usually lead to a sense of chilliness, which makes the warm bedclothes 
extremely comfortable on again getting into bed, and which is followed 
by sound sleep. 

"At other times an increase of the body temperature is the cause of 
disturbed sleep, sometimes amounting to sleeplessness. This is most 
frequently seen in febrile states, where a delirious condition takes the place 



842 DISEASES OF THE NERVOUS SYSTEM. 

oi natural Bleep. After the temperature has been brought down by the 
application of cold, a fever-patient will commonly fall into refreshing sleep, 
until a return to a fever temperature disturbs it. In slighter conditions of 
restlessness, associated with too great a body temperature, the dissipation 
of a certain amount of superfluous heat by getting out of bed and drinking 
a draught of cold water, will usually be followed by sound sleep. At 
other times, throwing off some of the bedclothes will achieve the same 
end; though, if the amount removed be too great, wakefulness may follow, 
from a too low temperature being brought about. With some persons, 
when the rest is disturbed, it is sufficient to protrude an arm or a leg from 
under the bedclothes, so as to secure more loss of heat, and sound sleep 
will follow:' 

Sleeplessness is sometimes due to an increased flow of blood to the 
brain, accompanied with excitement in the circulation generally. This 
condition may be associated with inflammations within the body or head; 
it may be due to sensations of pain, or to great distention of the blood- 
vessels of the brain, as in the excitement of delirium. Sleeplessness is 
dependent upon the so-called anaemia of the brain incident upon impover- 
ishment of the blood. In this form there is a disposition to sleep during 
the day, and especially when the upright position is assumed, but this is 
displaced by a state of wakefulness on lying down at night. One of the 
most potent causes of sleeplessness is irritability of the brain, induced by 
severe and long continued intellectual efforts, anxiety, and other depress- 
ing mental influences. In this condition, patients, as Niemeyer says, " can- 
not stay long in one place, go about restlessly, are worried, arid are 
conscience-stricken about slight trifles." 

According to Dr. Hammond, in slight cases of insomnia those measures 
are effectual which by their tendency to soothe the nervous system, or to 
distract the attention, diminish the action of the heart and blood-vessels, 
or correct irregularities in their function, and thus lessen the amount of 
blood in the brain. Among this class of measures are music, monotonous 
sounds, gentle frictions of the surface of the body, soft, undulatory move- 
ments, the repetition by the wakeful person of a series of words, as in 
counting, until the attention is diverted from the existing emotion which 
engages to it. The old monk's prescription for sleeplessness was "tell your 
beads." In persistent insomnia, however, these expedients are ineffectual, 
and means must be employed to improve the general health. Hygienic 
measures should never be neglected, and they are often sufficient to 
effect a cure. 

It is a popular error to suppose that a moderately full meal eaten 
before bed-time is necessarily productive of wakefulness; there is no 
doubt that this condition is induced by an excessive quantity of irritating 
or indigestible food. A hearty supper of plainly cooked and nutritious 
food rather predisposes to sleep. This is due to the fact that the process 



INSOMNIA. 343 

of digestion requires an increased amount of blood in the organs which 
perforin it, and consequently the quantity in the brain is diminished. 
This sleep-producing effect is neutralized, however, when the food is 
immoderate in amount, or irritative in quality. Dietetic treatment is there- 
fore essential in the victims of insomnia. As a rule they are underfed. 
This is especially true of women, in whom the affection is very often due 
to anaemia. These patients require not only nutritious food but stimu- 
lants. Rich and tonic wines, or malt liquors, should be judiciously taken 
with the meals. Of the use of alcohol in insomnia it has been said that, if 
there be any use of it that is free from objections, it is its use as a narcotic 
in certain conditions. With many persons a dose of alcoholic stimulants 
at bed-time is the very best nightcap they could possibly resort to. 
The cases best adapted to its use are those where there are mental worry 
and anxiety. In such states the first effect of alcohol in removing gloom, 
and substituting pleasing sensations for unpleasant thoughts, is eminently 
useful. Stimulants should only be employed in those cases attended 
with debility. 

There are cases in which coffee induces sleep ; in females of languid 
circulation and a consequent tendency to internal congestions, it is partic- 
ularly serviceable. Warm baths exert a soothing action on the nervous 
system, and determine the blood from the head. Applications of cold 
sometimes favor sleep in those cases of insomnia in which the individual is 
strong, the heart beating with force and frequency, and the mental excite- 
ment great. 

In the British Medical Journal, January, 1885, Mr. A. J. Campbell 
suggests a most pleasant and soothing method of employing the douche in 
cases of insomnia. The patient's shoulders having been wrapped in a 
sheet or blanket, and his ears plugged with cotton-wool, his head is sup- 
ported over the edge of the bed (a suitable vessel being placed underneath 
to receive the water), whilst a gentle stream of water from the rose-spout 
of an ordinary watering-pot is directed over the head and neck. The 
watering-pot should be held at least eighteen inches above the level of the 
patient's head, and the douching may be kept up for three or four minutes; 
the head should then be lightly dried with a towel, and the patient lifted 
into his ordinary position in bed. As a rule, sleep is produced within a 
short period. 

Physical exercise in the open air, extended to the point of inducing 
slight fatigue, is productive of good results. As previously stated, the hygi- 
enic measures ought never to be neglected; reforms should be instituted, 
and all pernicious habits and seemingly trifling irregularities corrected. 
In insomnia dependent upon severe and long continued mental exertion 
all means will fail if the individual will not consent to use his brain in a 
rational manner. Proper intervals of relaxation must be insisted upon, 
and in some cases complete mental rest. Travel is always of the greatest 



344 DISEASES OF THE NERVOUS SYSTEM. 

advantage in such cases; bodily exercise is one of the absolute essentials. 
Horseback riding is a most pleasurable form of exercise, and is productive 
of good results. C. Handfield Jones says that, among the various sopor- 
ifics, it is doubtful whether any are more potent, especially for the weakly 
and excessively sensitive, than prolonged exposure to the cold open air. 
This should be so managed as not to cause great fatigue, and should be 
followed by a sufficient meal. 

Except when associated with pain, rarely will persistent insomnia 
demand the use of sleep-producing drugs. Under no condition should 
they be used until all other measures have proved unserviceable. In fact, 
the rule should be to treat the affection by removing all pernicious influ- 
ences, correcting associate abnormal conditions, toning up the system, and 
thereby improving the general health. In the treatment of no other dis- 
order is common sense so essential and drugs of such little value. 

There remains to consider a few of the most common sleep-producing 
agents, it being assumed that, in some cases, their occasional use will be 
indicated. When insomnia is induced by pain, in some form opium is 
needed. If fever is present, it is well to use Dover's powder. The 
hydrate of chloral is a popular remedy, and one often very injudiciously 
employed. Doubtless it is most commonly used where the inability to 
sleep is due to mental disquietude from an overtaxed and exhausted state 
of the brain. In such cases it is objectionable and mischievous. For the 
sleeplessness of fevers this agent is serviceable, and to such conditions its 
use should be confined. As one author says, " the persistent resort to 
chloral hydrate is most disastrous in its consequences, and the temporary 
relief afforded by it is not to be set against its after effects." The bromide 
of potassium is a powerful sleep-producing agent ; it is a direct and abso- 
lutely safe brain-sedative. When given alone, the dose should be thirty 
grains. Its constant use, however, leads to diminished brain-activity, and 
to impairment of the intellect. In cases of delirium tremens this remedy 
may be judiciously combined with chloral, as in the following mixture: — 

R Chloral hydrat 

Potass bromid aa 3 ij. 

Aquse $ ij. 

Ft. mist. Sig. : Dose, one teaspoonful. 

Of this preparation one teaspoonful may be given every fifteen minutes 
until sleep is produced. 



CHAPTER IV. 
RABIES. 

The antiquity of hydrophobia, or, more properly, rabies, is not precisely 
known. Aristotle is the first author to mention this malady, but his 
account of it is remarkably incorrect, if the text be not corrupted. He 
says: "All animals that are bitten by a rabid dog are affected with the 
disease except man; and the disease proves fatal to all animals but 
man." Among the ancient authors, Caelius Aurelianus treated all the 
important questions relating to hydrophobia in a most masterly manner. 
After him centuries passed during which, with but few exceptions, inde- 
pendent observations censed, and little or nothing was added to the pre- 
vious knowledge on the subject. Investigations were renewed towards 
the end of the last century by Hunter and other intelligent observers, and 
recently a more exact knowledge of the disease has been acquired through 
the studies and experiments of Hertwig, Meynell, Youatt, Magendie, 
Blaine, Virchow, Pasteur, Reder, and others. 

Rabies, which prevails chiefly among animals of the canine species 
(dog, wolf, fox, jackal), is at the present time accepted as being an acute 
infectious disease, coming on in the form of a functional disturbance of 
the central nervous system, without structural changes which can be con- 
sidered essential to the affection. Examinations after death have revealed 
in most cases diseased appearances, but not one has been found to be 
present invariably, and no local changes have been discovered which 
could explain all the symptoms. 

The theory of a spontaneous development of rabies, so frequently 
advanced, has been rejected as entirely unfounded. It is unnecessary to 
enumerate and describe all the influences which have been cited as pre- 
disposing and accidental causes; in wearisome arguments the best authori- 
ties have proved the theories untenable and unfounded, and that all the 
causative conditions such as seasons of the year, extremes of tempera- 
ture, restraint, starvation, suppressed sexual appetite, age, sex, and race, 
are to be regarded neither as direct nor predisposing causes. It is now 
universally accepted that the poison is communicated almost invariably by 

345 



846 DISEASES OF THE NERVOUS SYSTEM. 

moans of the bite of a rabid or infected animal. The specific infecting 
principle of rabies is claimed by Pasteur to be rabic microbes, and Fol of 
Geneva is said to have isolated them. The virus is contained in the saliva 
and foam oi the diseased animal, also in the spinal cord, blood, and sali- 
vary glands; its existence in other portions of the body is conjectured, 
but not positively determined. It increases by internal growth, and from 
other poisons it is distinguished principally by this circumstance, that it 
remains within the vital organism for weeks, and even months, without 
producing any diseased symptoms whatever. 

Experiments have proved that the bite of an infected, though appar- 
ently healthy, dog, when inflicted during the period of incubation, or 
slow development of the disease, has even then the power of communica- 
ting it. Thamhayn collated nineteen cases, occurring in the human sub- 
ject, in which dogs, to all appearances healthy, but which subsequently 
became rabid, produced by their bite hydrophobia, the result being fatal 
in eighteen cases. 

The virus is probably capable of infection for some time after death, 
but hardly longer than twenty-four hours. That the same is inactive when 
brought into contact witli the unbroken mucous membrane of the digestive 
canal, is confirmed by the experiments of Hertwig; at one time he intro- 
duced the saliva and mucus of a rabid dog into the mouths and throats of 
healthy animals; again he fed dogs on food with which not only the 
infected saliva and mucus had been mixed, but to which also warm blood 
taken from rabid animals had been added, all with negative results. He 
placed healthy dogs in stalls where others affected with rabies had just 
previously been kept, so that they were brought in frequent contact with 
the same straw, chains, food, and drinking basins that had been used by 
the diseased animals, but in no instance was rabies produced ; and the 
same may be said of placing healthy animals in the stall with dogs which 
had recently died of the disease. 

The theory that the poison is very rarely communicated in any other 
way than by the bite of a rabid animal, or by inoculation, is fully eon- 
firmed by the most wearisome experiments. No instance is as vet known 
where the virus has been transferred by intermediate vehicles. An inge- 
nious theory has been suggested, that if minute particles of the poison 
suffice to propagate infection, possibly certain parasites, fleas, lice, which 
are nourished by the blood of the dog, and which the more often infest 
them, may transfer the poison by means of their blood-drawing apparatus, 
and thus produce inoculation. It is inferred that an analogy exists with 
other infectious diseases, as for instance small-pox, which has been unques- 
tionably transported by flies, and the same is true in cases of malignant 
pustule. In the latter contagious and very fatal malady, it is believed that 
flies which have alighted on the ulcers of diseased animals convey the 
virus, and infect other animals and human beimrs. 



RABIES. 347 

The period of incubation, or development of the disease, is variously 

estimated by different authors; in the majority of eases it lasts from three 
to five weeks. The two extremes in a dog which have been reported are : 
the shortest, one week; the longest, eight months. Rabies assumes two 
forms: the violent; and the dumb, or sullen. Hertwig has said that two 
cases rarely correspond. From this it can be appreciated that an accurate 
description of a disease presenting so many varieties and depending on so 
many influences, such as age, temperament, condition, etc., is no easy task. 
The violent or furious has been divided by some authors into three stages ; 
the melancholic, irritative, and paralytic. 

At the outset of the disease the animal manifests a changed manner, 
becoming irritable, sullen, and nervous ; his disposition towards those 
around him is capricious; to his, master he is often even more friendly 
and confiding, but from others, of whom he seems suspicious, he shrinks, 
and is easily enraged by their interference. He is disposed to shun com- 
panionship, slinking away in dark and obscure places, and, when called, 
conies reluctantly, his manner crouching and frightened. In this stage 
the eyes are slightly reddened and wear a changed expression as has been 
described, a vacant, far-away, listless look ; often they change, and, in con- 
sequence of the wrinkles in the forehead, the gaze becomes sullen and 
ferocious. It is difficult to fix his attention for more than a moment, 
when his eyes will close in a sleepy manner, and remain shut for several 
seconds. 

According to the most experienced observers, a perverted appetite is 
one of the most constant morbid symptoms. Food is the more often 
rejected or eaten sparingly, and at times it is taken into the mouth and 
dropped again. On the other hand, all sorts of indigestible substances — 
Sticks, straw, rags, earth, hair, dung, and the like, are swallowed. The 
desire to chew something is irresistible ; due, possibly, to a peculiar feeling 
in the jaws excited by an irritation of the nerves. If allowed in the 
house he will bite and worry chair-legs, carpets, boots, etc., in fact any- 
thing he can fix his jaws upon. A tendency to lap cold objects such as 
stones, iron, and his own urine, is observed. In some cases the sexual 
desire seems stimulated, as indicated by the disposition to lick the geni- 
tals of other dogs. A mucous discharge appears at the nose, and the 
secretions in the mouth and throat become thick and ropy, which the 
animal will occasionally make efforts to expel, and possibly attempt to 
vomit. This trouble about the throat has led to a mistaken diagnosis of a 
bone being lodged there. 

The duration of this stage, denominated the melancholic, may be but a 
few hours, and rarely over two or three days. It must be remembered 
that not all the symptoms are uniformly present; in some cases they are 
few and insignificant, possibly overlooked, or, if detected, sufficient impor- 
tance is not attached to them ; a fact which renders this period in the dis- 
ease the most damrerous to man. 



348 DISEASES OF THE NERVOUS SYSTEM. 

The so-called irritative or maniacal stage has more defined and charac- 
teristic 1 symptoms, which appear spasmodically, with intervals between the 
attacks, during which the animal is far less violent. Among the most 
important symptoms are a changed behavior, an irresistible disposition to 
bite, a peculiar bark, and repeated violent efforts to break away and stray 
about. Of this latter symptom Hertwig has observed that the desertion 
of his home by a previously faithful dog indicates the existence of a high 
degree of mental disturbance. The propensity to stray off, especially after 
having been excited or corrected, is then often ascribed to fear, obstinacy, 
disobedience, or unsatisfied sexual desire, and the animal is all the more 
dangerous in this state if he quietly and peaceably returns home. When 
at large no definite object possesses the animal, and he will often travel 
fast and far within a short time; expressive of this the term " running 
rabies" was formerly used. Sometimes he will return home slyly and sus- 
piciously, but friendly with his master. 

As the disease passes into the violent stage, the unfortunate animal 
grows more restless and on the alert ; at times becomes delirious, possessed, 
as it were, by spectral illusions ; springs at the door as though he heard 
some one approaching ; again, he will examine every part of his kennel, or 
room in which he is confined, in a most minute manner, — then retire to an 
obscure corner, to remain but for a few moments, and again commence his 
wearisome search. At times his eyes are fixed on some imaginary insect, 
which with his gaze he seems to follow in its course along the walls ; at 
last he springs forward, snapping at the intruder his mind pictures, when 
the spell seems broken, and he returns to his corner, as though ashamed of 
his delusion. 

As the disease progresses, dogs that are fastened will struggle to break 
their chains ; those that are confined within a room will bite into the wood- 
work, or roll about in the straw, which they shake in their teeth. The 
violent paroxysms become longer and more severe, sometimes lasting for 
several hours, during which the dog snaps and bites at whatever he 
encounters ; they seem prompted to attack other animals, large and small, 
and, less often, man. Not infrequently a rabid animal will bite and lacerate 
his own body, even to gnawing his feet to the bone ; cases are on record of 
terrible self-mutilation ; some are insensible to external impressions, and 
will bear blows without a cry, and bite at red-hot irons. If a stick is 
extended to a chained dog, he will snap at it, and cling with such force 
that his teeth will break and his lips bleed. 

Paroxysms are excited by teasing, the sight of other animals, or may 
occur without provocation. While they last the dog is possessed with 
unusual strength, often breaking his chain and freeing himself. Bitches 
with whelps have been known to bite and tear their pups with their teeth. 
During these paroxysms, those infected seem perfectly delirious, and fre- 
quently there are observed convulsive twitchings of the face, and occasion- 



RABIES. 349 

ally convulsions. Following the attack, the animal relapses into a sort of 
stupor, and, it' undisturbed, a much longer interval will more often elapse 
before a recurrence of another period of excitement. In some cases the 
mental state is for a time so improved masters are recognized. 

A sign which is considered highly characteristic of rabies, and one 
which frequently makes its appearance early in the disease, is the peculiar 
alteration in the tone of the voice ; the bark is described as a sound 
between a bark and a howl, uttered in a rough, hoarse tone, which might be 
called croupy. The short, sharp sound is often prolonged into a mournful, 
distressing wail, the animal lifting his head in the air as it issues. The 
change in the voice is attributed by some to a swollen condition of the 
pharynx and larynx ; this is possibly true, and yet certain functional dis- 
turbances in the great nerve-centres may be even more active, as, in cases 
of children suffering from diseases of the brain, the cry becomes harsh, 
shrill, and ear-piercing. In the maniacal stage of rabies, the appetite for 
food nearly, if not entirely, disappears; occasionally a favorite bit, if 
offered, will be eaten, but rarely is this the case. Instead of food, a rabid 
animal will invariably swallow large quantities of indigestible substances, 
such as straw, clay, and clung. 

Among the many ancient and unfounded traditions concerning the 
course of rabies, may be recalled the notions that dogs so infected froth 
and foam at the mouth ; that they always run in a straight line, and carry 
their tails held closely between the hind legs ; also that a peculiar odor 
attends a rabid dog, which can be detected by one in health. All this is 
fanciful and unfounded ; authorities state that the saliva is discharged only 
when the animal is unable to swallow ; the tail is wagged and carried as 
usual, until weakness causes it to drop ; in running, the course is much the 
same pursued by one uninfected. The gait of a rabid dog is somewhat 
characteristic, described as a jog-trot. He carries his head low, with 
tongue protruding, often torn and bleeding, swollen, and covered with 
dirt. Rarely will he turn from the course he is pursuing to attack any- 
thing, unless it be animals of kindred species, the sight of which almost 
invariably excites his rage and invites an encounter. 

At no time during an attack of rabies is there a special dread of water, 
as was formerly popularly supposed. One observer is credited with having 
detected, in extremely rare instances, dogs unable to swallow, owing to 
spasms of the throat. Almost invariably they drink freely and deeply 
showing no nervous excitement at the sio-ht of fluids. It is not an uncom- 
mon sight to see them lick their own urine, a fact upon which much stress 
as a diagnostic sign is put by some authors. 

As the disease progresses, emaciation rapidly supervenes, the entire 
appearance of the animal becomes changed to a marked degree; the head 
frequently swells ; the eyes, which sink wdthin their cavities, are brilliant 
and glistening; the hair becomes rough and staring. The mucous mem- 



350 DISEASES OF THE NERVOUS SYSTEM. 

brane, more often dry and parched than moistened, changes to a purplish 
color. The breathing during a violent paroxysm and immediately after is 
harried : at other times, it is but slightly affected. 

The duration of the violent or irritative stage is generally not longer 
than three, or very rarely four days. As the rabid animal beeomes weak- 
ened and the paroxysms grow less severe and distinct, the disease emerges 
into the so-called paralytic stage. The change in appearance now becomes 
more striking; surprisingly so, considering the few days that have passed 
since the appearance of the first symptoms. The eyes are dim and glisten- 
ing, the purplish tongue protudes, emaciation has reduced the unfortunate 
to a mere skeleton ; he presents a picture both appalling and heart-rend- 
ing. He. staggers and stumbles blindly about his kennel, until increasing 
exhaustion at last overpowers him; he will still bite or snap at things 
which may be used to arouse him ; but his strength departing, Lis efforts 
grow more feeble, his breathing is short and labored, his voice hoarser ; 
he passes into a stupor, possibly into a partial or complete convulsion, and 
at last death mercifully closes the scene. 

The progress of this terribly malady is very rapid. The different stages 
may be passed and death ensue on the second, or life may be prolonged to 
the tenth day ; the latter set as the limit is but rarely reached, and from 
four to five days is the more common duration. The dumb or sullen form 
of rabies which constitutes from fifteen to twenty per cent of the total 
number of cases, is but a peculiar type of the disease, which runs a much 
shorter course, and without the violent or irritative stage. There is decid- 
edly less excitation of the brain, the violent paroxysms, the illusions, the 
constant motion, the disposition to bite, and the propensity to stray away, 
are all absent, or present only in a slight degree, and the animal is quiet, 
silent, and dejected. 

Paralysis of the muscles of the low^er jaw is a characteristic symptom 
of this form of the malady, and manifests itself early in the attack. The 
jaw drops and the mouth remains constantly open. In rare cases a partial 
control of the muscles is retained, sufficient to lift the jaw and possibly 
allow the animal to bite if sufficiently irritated. Rarely more than a few 
hours, possibly three or four, elapse, after the disease manifests itself, 
before this symjitom appears. There is great difficulty in swallowing, and 
the poor dog will plunge his muzzle into the water up to the very eyes in 
order that he may get one drop into the back part of his mouth to cool 
his parched throat. It is in this form of rabies that frothing is observed, 
the flow of mucus and saliva in abundance dripping from the open mouth. 
The voice, changed and of a hoarse tone, is seldom heard, and that pecul- 
iar combination of bark and howl, characteristic of the violent form of 
the disease, is entirely absent. 

Death in the dumb form of rabies results more quickly, life being but 
rarely prolonged more than two or three days. The appearance of the 



RABIES. B51 

eyes, and generally haggard and depressed look, marking the derangement 
of the brain; the loss of appetite, the rapid emaciation and paralysis, arc 
symptoms resembling much those seen in the violent attack. Doth forms 
of the disease have appeared in the same kennels, and at the same lime; 
inoculation from dogs suffering from the one variety may give rise to either 
violent or dumb madness. 

In some cases of rabies a diagnosis will be difficult, while in others the 
signs will be sufficiently pronounced to render the task easier. It is to be 
remembered that but few animals can compare with the dog in intelligence 
and high mental development; that he possesses a sensitive and easily 
excited nature, and is extremely liable to contract nervous derangements 
and diseases. This fact is demonstrated by the frequent occurrence of 
convulsions, chorea, and kindred disorders. Again it is more than probable 
that the study of canine ailments will yet prove to observers the existence 
in dogs of mental diseases, at present overlooked and unsuspected. 

When an animal presents certain symptoms which are known to appear 
in rabies, all, the medical men by no means excepted, are much too ready 
to jump at conclusions, and condemn to execution a poor animal as rabid, 
when he may be suffering from either meningitis, epilepsy, severe pain, 
excessive fear, neuralgia, starvation, toothache, parasites in the nasal 
cavity, acute otitis, disease of the kidneys, or some disturbance of the 
brain of which at present we have no knowledge. Nor must be forgotten 
the action of certain irritant poisons which when swallowed cause intense 
inflammation of the throat, stomach, and intestines. Few there are who 
have not seen dogs in a state of delirium caused by the action of the 
intense heat of the sun. Others doubtless have witnessed the extreme 
mental disturbance of a bitch deprived of her Avhelps, and the distress and 
efforts of an animal to free himself from restraint in a new home, and 
return to his old master and those he loves. 

Some readers will naturally observe that to mistake for rabies many of 
the diseases referred to must be impossible, and yet such errors are more 
easil) r made than they imagine, for not only in these, but in other diseases, 
unmentioned, there occur symptoms resembling somewhat those of the 
dread malady. Again it must be remembered that fear prejudices reason, 
dulls perception, and blunts judgment; even the thoughts of hydrophobia 
incite a measure of terror, and important symptoms are overlooked, while 
many in nowise significant become pronounced. As one authority hns 
said, " in forming the diagnosis, we should have constantly before us a 
picture of the disease as a whole, and never base an opinion upon indi- 
vidual symptoms, such as the propensity to bite, which may be slight, or 
even entirely absent." 

Passing in review, the characteristic symptoms of the violent form of 
rabies are: the marked uneasiness, the delirium and very great excitement 
occurring in paroxysmal attacks, the tendency to bite, the efforts to break 



852 DISEASES OF THE NERVOUS SYSTEM. 

away, the peculiarly changed voice, the perverted appetite, the rapid 
emaciation, exhaustion, ami invariably fatal termination. In the sullen or 
dumb form the violent stage is omitted or hardly recognizable; it runs an 
extremely rapid course, the animals are quiet and depressed, have but little 
disposition to bite or run away; early in the disease they are paralyzed 
in the lower jaw, have perverted appetite, changed voice (rarely heard), 
progressive emaciation and exhaustion, and seldom live beyond the third 
day. 

Preventive Treatment. Immediately after the bite of an animal pre- 
sumably rabid, the whole wound should be sucked, and as soon as possible 
thoroughly cauterized. If there are no abrasions on the lips or tongue, 
there can be no danger whatever from the virus on the part of the one 
who applies suction. During the time the lips are employed, the mouth 
should be frequently rinsed with warm water, and the teeth used freely 
in gnawing, as it were, the edges, to keep the wounded vessels open and 
bleeding. To promote a flow of blood, which is decidedly favorable, a 
cord or handkerchief can be tied fairly tight between the wounded part 
and the body. Suction should be persisted in until the bite can be cauter- 
ized, and discontinued as soon as that operation is possible. If the indi- 
vidual bitten lives at a distance from the chemist's, and delay must ensue 
before medicinal caustics are obtained, a hot iron should be depended 
upon, and the wound thoroughly burned. 

The chemical and corrosive agents penetrate every part of the injury 
with greater certainty, and when possible they should be secured. The 
most active are nitric, sulphuric, and carbolic acids, caustic potassa, and 
nitrate of silver. The latter was strongly urged by Mr. Youatt who cer- 
tainly proved its efficacy since he w T as bitten many times and escaped, 
though he used no other preventive ; he also observed instances in which 
out of several animals bitten by the same dog, those which were cauter- 
ized by the nitrate of silver escaped, while some which had the wound 
incised, or cauterized with a hot iron, were subsequently infected with 
rabies. 

Regarding the sucking of a wound made by a suspected animal, it is of 
interest to recall the fact that in Lyons, during the first twenty years of 
the present century, certain women made it their business to apply suction 
to the wounds made by rabid dogs, for which they were paid ten francs for 
the first operation, and five for each succeeding one. Of thirty-eight per- 
sons bitten and subsequently subjected to this operation, not one con- 
tracted hydrophobia. 

It is yet an unsettled question whether or not it is wise to allow the 
wound made by a bite to heal naturally and at once, or to keep up the 
inflammation by applications. The latter is generally accepted as the better, 
and for the purpose caustic can be used every few days, as the need is 
manifest, or a dressing of the resin-ointment may be applied. In four or 



RABIES. 353 

five weeks the wound should he allowed to heal. It is estimated that in 
those cases where cauterization is resorted to only a very small per cent of 
the human beings bitten by rabid animals fall victims to the disease; in 
cases where the operation is not performed, according to Bollinger, forty- 
seven per cent meet certain death. 

The writer has pictured with wearisome detail the symptoms and 
phenomena which attend both forms of rabies. During the last century 
the public mind has been much wrought and depressed by constant allu- 
sion to the malady. Communities have often been terrorized by the 
appearance in their midst of dogs supposed to be rabid, and many a valu- 
able pet has met his death from the hands of the poisoner, incited to the 
hellish deed through the cowardly fear of a disease so rare the dangers 
from it are almost nil. 

Scientific research and advancement in knowledge of this subject have 
been so obstructed by ignorance and superstition, transmitted from the dark 
ages, the general public are to-day as destitute of a proper understanding 
of rabies, and are endowed with as wild fancies, absurd theories, and fan- 
atical notions as were those of a hundred years ago. 

From the BritisJi Medical Journal we quote the following on this sub- 
ject: "Something should be done to disabuse the public mind of a ground- 
less or greatly exaggerated terror. It would be amusing, if it were not 
grimly sad, to observe, not unfrequently, the insane evidence of a purely 
mimetic morbid state, set up by the misery and apprehension caused by 
the consciousness of having been bitten by a mad dog. As a matter of 
sober medical fact, it is by no means necessary or inevitable that the bite 
of a dog with rabies should give a man or woman hydrophobia; and if the 
element of fear could be eliminated, it is highly probable that the propor- 
tion of instances in which the dreaded disease supervened from a bite 
would be greatly reduced." 

Many pages have been devoted to this subject, for the writer has felt 
his duty imperatively demanded that an exhaustive description of the 
symptoms and phenomena of rabies be pictured by him to the reader. 
Although he has never been able to appreciate why people are possessed by 
that insane terror of a disease so rare that death by the hand of the execu- 
tioner might with equal good sense be anticipated, he has felt that super- 
stition, and an ignorance of the subject, were conditions favorable to the 
propagation of the common terror, and only by enlightenment born of a 
perfect understanding of the disease and its actual, not imaginary, dangers. 
can the public mind be disabused, and the groundless terror dispelled. 



SECTION VII.— I. 
SIMPLE AND PERIODICAL FETERS. 



CHAPTER I. 

FEBRICULA. 



The term febricula, meaning little fever, is used to designate a form 
of fever characterized by its mildness and short duration. It has been 
known by a variety of names. If very short, lasting only a single day, 
Flint calls it ephemeral fever. When continuing for a period of from 
three to eight days, it is frequently denominated simple continued or simple 
fever. 

This febrile disturbance generally results from "catching cold." A 
variety of other ordinary causes are, however, capable of producing it, 
among them over-exertion, dietetic excesses, etc. After exposure to the 
causative influences, the first signs of illness may show themselves within a 
few hours, or be delayed one or two days. Febricula is usually developed 
abruptly, but in a certain proportion of cases for two or three days there 
are general malaise, languor of body and mind, loss of appetite, and a 
special disposition to shivering and chilly sensations, to cold hands and feet. 
The febrile movement varies in intensity. In the majority of cases, there 
are quickened pulse, flushed face, and the skin is dry and burning. Head- 
ache is usually pronounced, and dull, aching pains are felt throughout the 
body, especially marked in the loins and limbs. Patients frequently com- 
plain that they "feel sore all over." The loss of appetite is generally 
complete ; the tongue may be thickly coated. In nearly all cases, constipa- 
tion co-exists; the urine is scanty and high-colored. Occasionally there 
appears on the lips, nose, or cheeks, a closely packed group of vesicles. 
This eruption more often occurs in cases induced by exposure to cold, and 
when present it has considerable diagnostic importance. It is not always 
easy to discriminate between febricula and the early stage of one of the 
more serious fevers. In cases cf doubt, if the vesicles called herpes 
appear, they are an evidence of the causative influence of cold, and gener- 
ally indicate an affection of a mild type, which tends to rapid recovery. 

354 



INTERMITTENT FEVER. 3;").j 

Febriculn usually ends after two or three days; less often it persists for a 
week, and rarely beyond the latter period. The affection, when uncom- 
plicated, is never fatal in cold and temperate climates. The decline dt 
the fever is generally as rapid as its invasion, and recovery is soon 
completed. 

A large proportion of patients who suffer from febricula recover with- 
out medical aid; they leave the malady to Nature, or employ domestic 
remedies. Free perspiration facilitates recovery, and to secure this is the 
object of treatment. In mild cases, a hot foot-bath and a generous quan- 
tity of hot drink before retiring will be sufficient to induce profuse sweat- 
ing. If the fever is of great intensity, ten grains of quinine should be 
taken at bedtime, and repeated in two hours, if the skin remains hot and 
burning. Those patients who are easily affected by quinine, and who suf- 
fer head-symptoms from its use, will do well to take, instead of this agent, 
the tincture of aconite-root, in two-drop doses, every two hours, until the 
fever abates. A purgative should be employed early in the attack, and, 
usually, after it has acted the improvement is more rapid. Three compound 
cathartic pills generally secure relief from the constipation. After the fever 
has subsided, the patient should, in cold weather especially, guard against 
exposure for a few days, or the malady may return. 



INTERMITTENT FEVER. 

An intermittent fever is characterized by alternate paroxysms of fever 
at regular periods, with intervals of entire absence of febrile movement. 
To this affection a variety of names have been given, among them fever 
and ague, chill and fever, the shakes, swamp fever, Chagres fever, and 
Panama fever. In nearly all parts of the world this disease has been 
known to prevail to a greater or less extent, although, according to Loomis, 
the region of its development may be said to be limited by 63° north and 
57° south latitude. Within these parallels it is the more prevalent nearer 
the equator. 

In the majority of cases, attacks of intermittent fever come on sud- 
denly; occasionally, however, they are preceded by symptoms which are 
sufficiently defined to foretell an impending seizure. When pre-existing, 
these signs are manifested for a variable period, sometimes lasting for six 
or eight days, and even longer. They are often insignificant, consisting of 
short attacks of headache, darting pain in the eyes, twitchings of the 
eyelids, loss of appetite, chilly, creepy sensations over the body, yawnings, 
indisposition to exertion, and not infrequently sweating at night. In 
some patients the premonitory symptoms are much more severe, and 
consist of a feeling of exhaustion, mental confusion, dizziness, shooting 
pains in the limbs, distressing dreams, and marked gastric and intestinal 
disturbance. 



SIMPLE AND PERIODICAL FEVERS. 

The duration of the interval between the paroxysms is the basis of a 
division of the disease into different types. In the quotidian type, the 
paroxysms recur every Jay, and there is an interval of twenty-four hours 
from the beginning of one to the beginning of the next paroxysm. In the 
tertian type, they recur every third day, with an interval between eaeh of 
forty-eight hours. In the quartan type, the interval is about seventy-two 
hours, or the paroxysms recur on the fourth day. The last mentioned type 
is much less common than either of the others. Modifications of these 
exist in occasional cases. Thus, there is the double quotidian, in which two 
paroxysms occur daily ; usually one is severe, the other mild. In double 
tertian, a paroxysm occurs daily, but those on successive days take place 
at different hours, and exhibit different qualities. For instance, the first 
paroxysm maybe characterized by a severe chill and mild fever, while on 
the following day there may occur a short chill and severe fever. In the 
double quartan type, paroxysms occur on two successive days, and none on 
the third day. There are still other modifications, which it is unnecessary 
to describe. 

In the quotidian and tertian varieties, the paroxysms usually occur 
before noon ; in the quartan, they more often appear after the middle of 
the day. As a rule, in each individual case successive paroxysms recur at 
or near the same hour. The duration of the paroxysm varies with the 
type of fever. In the quotidian, it lasts from eight to ten hours ; in the 
tertian, from six to eight ; while in the quartan, from four to six hours. 
There are many exceptions to these rules. 

A paroxysm of intermittent fever is characterized by three stnges : the 
stage of chill, the hot stage, and the sweating stage. In the majority of 
cases, these are easy to distinguish. Entrance into the stage of chill is 
marked by a sensation of coldness, usually beginning in the loins, some- 
times in the extremities, and rapidly spreading over the entire body. The 
chill, which is variable in intensity, becomes constant ; in some cases, it is 
limited to slight chilly sensations, with shiverings; in others, it is extremely 
severe. In the graver cases, there are trembling of the lips, chattering of 
the teeth, and convulsive movements of the whole body, often sufficient to 
shake with considerable violence the bed of the patient. The skin is dry, 
pale, and becomes shrivelled, and presents the appearance familiar as "goose 
skin."' The eyes, dull and watery, are sunken, the nose pointed, the lips and 
nails blue, the fingers are waxy, and the skin on them is wrinkled, and devoid 
of sensibility. The mouth is dry, and the voice weak, husky, and tremulous : 
the respiration is short, rapid, and often sighing. Among other symptoms 
are mental irritability, anxiety, palpitation of the heart, a tightness of the 
chest, and pains in the head and limbs. Often thirst, nausea, and vomit- 
ing accompany the disease. The duration of this stage varies from a few 
moments to several hours; the average period which it exists is from one- 
half to three-quarters of an hour. 



INTERMITTENT FEVER. 357 

As the stage of chill is passing off, Hashes of heat are felt, usually at 
first in the extremities, and soon over the entire body. The hot stage is 
then entered; the trembling of the limbs ceases, and fever displaces the 
feeling of cold. The skin becomes burning hot, smooth, and its vessels 
swollen; the face is flushed, and the eyes red and fiery. The feeling of 
oppression in the chest disappears; pain in the back, loins, and limbs i- 
relieved, but the headache increases. The pulse is rapid, full, and bound- 
ing; respiration is accelerated and noisy. There are intense thirst, restless- 
ness, and mental disturbance, which, in extremely irritable persons, may 
increase to delirium. Patients frequently complain of roaring noises in 
their ears, and of seeing sparks and flashes of light. Herpetic vesicles 
sometimes appear about the mouth. This stage usually lasts from three to 
four hours ; it may be much shorter, and not infrequently it is extended to 
eight and even to twelve hours. 

After a longer or shorter time, a slight moisture appears in the armpits 
and groins, on the breast and forehead, and gradually spreads over the 
entire body. The patient soon becomes bathed in a profuse perspiration, 
and the sweating stage is then entered. He now feels relieved ; the fever, 
headache, thirst, restlessness, etc., cease. The breathing becomes freer and 
easier, and, the general condition is so improved, often a quiet and refresh- 
ing sleep follows. The duration of this stage is variable ; the average 
period is from three to four hours, 

The condition of the patient on waking varies much, according to the 
severity of the paroxysm. After light attacks, aside from a certain amount 
of debility, he usually feels quite well, and can generally return to his 
wonted occupation. If the paroxysm has been severe and prolonged, there 
is more or less functional disturbance. In many cases, marked prostration 
follows; dizziness is complained of, appetite and digestion are impaired, 
the tongue is coated, and the taste metallic. Over the regions of the liver 
and spleen there is tenderness on pressure, and not infrequently distention 
indicates enlargement of those organs. The bowels are irregular; pains in 
the limbs, ringing noises in the ears, and dimness of vision are among the 
symptoms complained of. When intermittent fever has existed for a long- 
period, all vital functions share in the depression, and general disturbance 
of the health of the patient manifests itself. Anaemia is incident to the 
disease, and the patient becomes pale, feeble, and physically and mentally 
incapable of great exertion. Not infrequently the skin is of a yellowish or 
sallow tint. General dropsy is an occasional consequence in long protracted 
cases characterized by frequent relapse. 

The exciting cause of simple intermittent fever is commonly known as 
malaria. This poisonous agent as generally accepted is introduced into 
the body through the lungs or through the stomach. The germs of this 
disease seem concentrated near the surface of the earth, for it is known 
that persons sleeping in an upper story may escape, when those sleeping 



dOO SIMPLE AN1> PERIODICAL FEVERS. 

on a level with the ground become affected. All influences which tend 
to depress the general health are recognized as predisposing causes to 
malarial poisoning. Among these may be included hunger, thirst, loss 
of sleep, intemperance, over-exertion of the mind and body, emotional 
disturbances, exposure to night air, to cold, excesses in eating and drink- 
ing, etc. 

The prognosis of simple intermittent fever under systematic treatment 
may be considered as good. There is a much less common form of this 
disease, familiarly known as pernicious, malignant, and congestive intermit- 
tent fever, which in general terminates fatally. The possibility that simple 
intermittent fever may prove serious if it is persistent must enter into the 
prognosis. If the patient withdraws from malarial influences, the disease 
in some instances entirely disappears. Often, however, recovery is only 
apparent, and while the paroxysms may cease altogether, yet the general 
health not infrequently continues to decline. Relapses are very liable to 
occur after a variable period, which, being overcome by appropriate treat- 
ment, may, after a time, again occur, and continue to do so three or four 
times. The type of the disease may also change ; in the relapse there 
seems a tendency for it to recur at shorter intervals. The remote effects 
of intermittent fever are degenerative changes in the kidneys, liver, and 
spleen, impoverishment of the blood, scurvy, tuberculosis, and certain ner- 
vous affections such as neuralgia, conditions of paralysis, severe mental 
disturbances, and even insanity. 

Of the preventive measures to be adopted by those who live in a 
malarious region Hertz says : " It is desirable to select the highest and 
driest residences, far removed from swamps, and never to have one's sleep- 
ing-rooms on the ground-floor, but upstairs, and, if possible, on the east 
or south side of the house. Fresh air and cleanliness must be secured, 
but the bedroom windows should always be closed during the night. The 
clothing must be appropriate to the climate ; in warm countries cotton 
underclothing and hose are enough ; in cooler climates they should be of 
wool. One should avoid getting wet and every means of taking cold, as 
well as remaining long in the vicinity of swamps, sitting out-of-doors in 
gardens that lie low or are inclosed by high trees or walls ; especially after 
rainy weather, and during the damp evenings, one should be indoors. 
Sleeping outdoors is very injurious, as well as bathing in rivers or lakes 
after sundown. In tropical regions strangers must also avoid exposure to 
the powerful heat of the sun, and all undue bodily or mental exertion. 
All excesses are to be shunned. The food should be simple and nourish- 
ing, and in accordance with the customs of the country ; such as highly 
seasoned food, fresh, good, and not too fat meat ; easily digestible fish ; 
fresh vegetables ; good new-baked bread or rice ; and for drink, good 
water, which has no possible connection with the swamps. Where such 



INTERMITTENT FEVER. 359 

water cannot be bad, let all that is used be boiled or filtered through char- 
coal, or let the artificial carbonic-acid water be used. Tea and coffee, 
good wine and even small quantities of brandy, are desirable. Raw salad, 
watery fruits in large quantities, as well as milk and beer, are injurious. 
Every feeling of sickness, and especially any gastric or intestinal catarrh, 
should be attended to." 

The sovereign remedial agent in the treatment of intermittent fever is 
quinine, and the most common forms in which it is employed are the sul- 
phate and the bisulphate ; owing to its greater solubility, the latter is 
preferable. Several methods are employed in giving quinine: some advo- 
cate the use of a single large dose to ward off an expected attack ; 
others prefer to give the remedy in small doses, repeated at intervals of 
two or three hours. The weight of evidence is in favor of the latter 
method ; still in some cases the former will be more effective. If the 
disease has existed but for a short time, five grains of quinine should be 
taken during the sweating stage, or as near as possible to the paroxysm 
which has passed, and repeated every four hours until ringing noises 
in the ears are experienced. Even if by this method the second occur- 
rence of a paroxysm is prevented, the use of the drug should for several 
weeks be persisted in, and given three or four times daily, in decreasing 
doses. 

Occasionally irritability of the stomach causes rejection of the qui- 
nine ; in such cases, it should be administered by enema or hypoder- 
mically. It is readily absorbed by the intestine, and some hold that 
it acts more efficiently when so given ; the quantity should be one- 
half larger than when given by the mouth. If quinine is not retained 
either by the stomach or by the rectum, it should be given hypoder- 
mically. 

In protracted cases of intermittent fever, in which disturbances of the 
liver and spleen are associated, the writer has found the best results from 
the following method : Take one pill of quinine, containing one and one- 
half grains, every two hours, until the paroxysms no longer occur. After 
this gain is accomplished, continue the pills for several weeks, taking 
one three or four times daily to prevent a relapse. At the same time 
employ the following : — 



gr. xx. 

ST. XX. 



J^, Hydrarg. chlor. mite ... 

Ext. colocynth. comp 

Ft. pil. No. 8. Sig. : Dose, as directed. 

Two of these pills should be taken every other night, at bedtime, for 
four nights; their use should then be discontinued. 

Ancemia and other abnormal states, occurring as sequels to intermittent 



360 SIMPLE AND PERIODICAL FEVERS. 

er, demand appropriate treatment. The diet should be generous and 
nutritious, and all the laws of hygiene carefully observed. 

Strangers who are about to visit malarial regions will do well to use 
quinine as a preventive measure. Two grains should at first be taken 
three or four times daily for the first week, or until the effect of the drug 
upon the head is noted; then the dose may be decreased, and need not be 
repeated oftener than two or three times daily. 



CHAPTER IT. 
YELLOW FEVER. 

Yellow fever is a disease which, as its name suggests, is characterized 
by a yellowish discoloration of the skin. From one of its most prominent 
symptoms it is popularly known as the black vomit. It prevails mainly in 
the tropical regions, within which it is never completely extinct ; a greater 
or less number of cases are constantly occurring there, and from time to 
time extended epidemics develop themselves. 

An attack of yellow fever is generally abrupt. In a proportion of cases 
it is preceded by headache, loss of appetite, lassitude, pains in the limbs, 
and chilly sensations. The duration of these symptoms when present is 
brief; in many cases they exist for a few hours, and rarely do they persist 
until the second day. The disease commences with a chill, which may be 
distinct and severe or of moderate intensity. Rigors are an occasional 
accompaniment. Fever rapidly follows the chill ; the face is flushed, the 
eyes are reddened and fiery ; violent headache, often confined to one side, 
and severe pains in the back and limbs, especially in the calves of the legs, 
are seldom absent. Nausea and vomiting may be among the early symp- 
toms, but rarely are they prominent until a later period. The pulse in this 
disease is peculiar; it seldom exceeds one hundred beats per minute, and 
has been known to fall as low as forty and even thirty per minute. It 
is compressible, and sometimes weak and small, offering no resistance to 
the touch ; the arteries seem, as it were, distended with gas, and hence the 
name "gaseous pulse." The mind is usually clear, but not infrequently 
delirium is manifested ; rarely is it violent, and patients seldom need to be 
restrained. 

The tongue is thickly coated with a whitish, often yellowish, coating, 
excepting on the edges and top, which remain red. It often bears the 
imprint of the teeth, and as the disease progresses it may become dry, brown, 
and cracked, resembling the typhoid tongue. The mucous membrane of 
the hard and soft palate is bright red at first, and subsequently becomes 
dropsical. The gums are also swollen, and bleed easily. There is marked 
sensitiveness on pressure over the pit of the stomach, and in severe cases 
pain in that region is a constant symptom. 

361 



362 SIMPLE AND PERIODICAL FEVERS. 

At the close of the first, or early on the second, day, a peculiar odor is 
perceived in many patients ; it resembles that which is emitted by dead 
bodies. About the third day the skin assumes a jaundiced hue, and this is 
especially marked on the chest and upper extremities. The external coat 
of the eye also becomes yellow. It seems universally accepted by those 
who have written on yellow fever that vomiting is present in all severe 
cases: this is not true, however, as it is sometimes absent. In a large pro- 
portion of fatal cases the so-called black vomit occurs. The fluid ejected 
from the stomach much resembles claret in color, and has a sediment not 
unlike coffee-grounds. This symptom, so characteristic of the disease, may 
occur within twenty-four hours after the attack, but more often it appears 
on the second or third day of the fever. 

During the third and fourth days, there is usually a remission of the 
fever, which lasts from a few hours to two or three days, after which a 
second rise in the temperature begins. This period is the so-called second 
sta^e. Diarrhoea occasionallv occurs, and the stools sometimes resemble 
tar or molasses. The urine usually becomes of a yellow or orange color, 
and is often smoky from the presence of blood. In severe cases, there is 
occasionally entire suppression of the urine. Hemorrhages are also liable 
to occur from different parts of the body ; purple spots under the skin are 
frequently observed in fatal cases. 

After the remission of the fever, the temperature again rises, and in 
about two days reaches its greatest height. If recovery takes place, the 
fall to the normal degree is rapid. After the second remission, convales- 
cence commences, or the disease passes into the so-called stage of relapse 
or exhaustion. The patient then presents a shocking spectacle, with 
sunken, expressionless countenance, either totally unconcerned and indif- 
ferent to his condition, or constantly tossing in ffeneral distress. The 
jaundice becomes intense, and the skin assumes a dark inahoganv color. 
Entire suppression of the mine is a symptom of frequent occurrence in 
severe cases, and is almost equally serious with black vomit. When 
death occurs, during the last few hours, patients generally fall into a deep 
stupor, out of which they do not again awake. In occasional cases, life 
goes suddenly out during a paroxysm of violent delirium ; convulsions are 
infrequent, yet sometimes occur. 

In mild cases ox the disease, which end in recovery, convalescence 
usually commences after the first remission of the fever. The patients are 
attacked in the same way as described, very suddenly, with a chill, but the 
fever is not intense, and the pains are not severe. Nausea and vomiting 
are not infrequent in such cases, but hemorrhages from the stomach and 
other situations do not occur. Jaundice is either wanting, or, when pres- 
ent, it is only slight. Diagnosis is not always easy in such cases; and but 
for the knowledge that the epidemic is prevalent, the disease might not be 
recognized. 



YELLOW FEVER. 363 

The symptoms herein described are those usually manifested in pro- 
nounced cases of yellow fever, as observed by the writer during one of the 
most fatal epidemics. It developed itself on board the U. S. steamer 
Alabama, at Key West, in 1863, and although many years have since passed, 
the horrors of that experience have never been, and can never be, forgotten. 
The first man attacked had been guilty of some trifling misdemeanor, for 
which he was punished by double irons and several days' confinement in 
the so-called "brig" of the ship. This was a space in the lower hold, 
dark, un ventilated, and a literal dungeon. The unfortunate victim during 
his confinement constantly complained of the vile odor of his prison, and 
begged to be released. The sanitary condition of this section in all ships 
is poor, owing to the presence of bilge-water; but his murinurings were 
unheeded, and he was forced to serve out his term of imprisonment, 
which was some four or five days. But a few hours passed after returning 
to his accustomed place among the crew before he was attacked with a 
chill, and then followed all the characteristic symptoms of the disea.se. 
The presence of this scourge led to a careful search for the contributing 
causes, and in the lower hold wns found a can of preserved meat in a 
state of advanced decomposition, the sickening stench of which loaded the 
air between the decks. Here were conditions favorable for the reception 
of the yellow-fever poison, that miasm which is universally recognized as 
the special cause. The question naturally arises, from whence came this 
specific poison ? It seems reasonable to suppose that it had been received 
into the ship some two weeks previous to the outbreak of the disease, for 
there was no yellow r fever at Key West, but there was an epidemic prevail- 
ing at Havana, in which port she was at anchor for one night. On that 
night a dense fog hung over the harbcr, and in that the miasm must have 
been conveyed, for not a man left the steamer, and no stranger from shore 
was allowed to board her. 

No pen can depict the sufferings of that fated crew, who for many 
weeks faced death in its most loathsome form. Confined within their nar- 
row limits, in settled despair they waited the summons of the destroyer. 
But a few among them all escaped the disease ; crushed beyond re-action 
by their mental tortures, the scourge found them easy victims. Some are 
at rest in San Domingo; many were buried at sea, and only a few saw 
their native land before they died. 

The experience of the writer sustains the assumption that yellow fever 
is not contagious, and is not directly transmissible from the sick to the 
healthy. All observers agree that the disease is portable, that it can be 
transported from one place to another, in clothing, merchandise, etc. 
Certain conditions are necessary for the propagation of this poison, when 
introduced into healthy localities. The temperature must be suited ; there 
must be a certain amount of moisture, and decomposing animal and vege- 
table matter. 



364 SIMPLE AND PERIODICAL FEVERS. 

With reference to treatment of yellow fever, judicious nursing is of 
mere importance than medication. Fluids should, as much as possible, be 
withheld. Cracked ice is useful to satisfy thirst and allay the irritability 
of the stomach. In many cases, milk and lime-water will be the only nour- 
ishment which can be well borne; small quantities frequently repeated 
should be the rule. Restlessness and sleeplessness call for opium. Aconite, 
and frequent sponge-baths are serviceable in lessening the febrile disturb- 
ance. Early in the attack it will be well to give a dose of castor-oil, or 
administer an injection of soap-suds; purgatives are not allowable. If 
there is a tendency to collapse, stimulants must be given, and there is none 
that taxes the stomach less than champagne. Perfect quiet, absolute rest, 
pure air, and cleanliness are among the essential measures. It should be 
borne in mind that the kidneys but imperfectly perform their functions in 
all cases, and may become pow T erless. It is therefore important that the 
activity of the skin be maintained, and, if the patients retain their strength 
well, free perspiration may be promoted by an abundance of clothing. 



SECTION VIL — II. 
CONTINUED FEVEES, 



TYPHOID FEVER. 



The expression Typhus (ivcpo;) signified originally smoke, vapor, and 
was afterwards used to denote impaired intellectual sensibility. The name 
typhoid signifies typhus-like^ and its application to the fever about to be 
considered implies a resemblance of the disease to typhus fever. As uni- 
versally accepted at the present time, the only likeness between them, 
except that they both are infectious diseases, is, that in both affections, 
many of the cases are attended with severe and long continued fever. 
Liebermeister claims that in every other respect they are different. 
Typhus fever has more analogies with small-pox, measles, and scarlet 
fever, than with typhoid fever ; while the latter in its production and 
mode of propagation resembles dysentery and cholera much more than it 
does typhus. 

In typhoid fever there are structural changes in the intestine which 
are characteristic of the disease. There are also important changes in 
other organs of the body, nearly all of which, however, are common to 
many infectious diseases. During the first week of the fever, there is 
developed a catarrhal inflammation of the mucous membrane of the small 
intestine, together with a swelling of the solitary glands and aggregation 
of glands called " Peyers patches" situated therein. In the second week 
the general congestion of the mucous membrane subsides, and the gland- 
ular swelling increases. During the week ulcerative processes commence 
in these swollen glands. In the third week ulcers are fully formed. After 
this, follows the period of repair, the healing of the ulcers occupying a 
variable time. 

Typhoid fever, as a rule, comes on gradually, with vague and ill defined 
symptoms. For from five to ten days previous to the outbreak of the 
disease, the patient attacked usually complains of "a tired feeling all 
over," a grumbling headache, the pain generally referred to the forehead, 
and more or less aching of the limbs ; sleep is broken and disturbed by 

365 



366 CONTINUED FEVERS. 

dreams; he becomes irritable, and finds it difficult to concentrate his 
attention or exert the faculties of the mind. The countenance presents a 
dull dejected expression, in keeping with the indolent movements. The 
tongue is coated and slightly swollen; there are loss of appetite, occasional 
nausea, and vomiting. Sometimes there are slight pains in the bowels, and 
diarrhoea, but these symptoms are infrequently pronounced unless cathartic 
medicines have been employed. Chilly sensations, recurring irregularly, 
alternating with Hashes of heat, are usually experienced. Bleeding at the 
nose occurs in a large proportion of cases. 

In some cases the symptoms described are of mild intensity, and the 
patient affected is able to pursue his ordinary avocations until the tenth 
day. More often, however, lassitude and progressive debility compel him 
to take his bed on the fifth or sixth day. This prodromic or preceding 
stage has often no defined limits; it usually begins gradually and passes 
imperceptibly into the disease. Exceptionally the attack is abrupt, the 
patient taking at once to the bed. During this period a positive diagnosis 
of typhoid fever is impossible, as the symptoms are not sufficiently distinc- 
tive. The prodromic stage ends when the disease is developed and the 
febrile movement begins. In a large proportion of cases there are no 
definite data, so imperceptible is its approach, and it is customary to 
regard as the beginning of the disease the day on which the patient 
becomes unfit for work, or is obliged to take to his bed. 

During the first week after the prodromic stage has passed and typhoid 
fever is developed, the fever gradually and steadily increases, with regular 
morning and evening variations. Each evening the temperature is about 
two decrees higher than that of the morning, and one degree higher than 
the previous night, so that at the end of the first week it is at its maxi- 
mum, which is usually 104° or 105°. This daily variation and gradual 
increase of the fever is one of the most characteristic features of the 
disease. Even without a thermometer the febrile changes are often appar- 
ent to the observer. The skin is usually dry ; sometimes, especially in the 
morning, it is moist. Not infrequently in the afternoon slight chills are 
experienced. During this, the first week, the symptoms which were 
present in the prodromic stage gradually increase in severity. The pain 
in the head usually becomes more distressing; it is not violent, but of a 
dull, heavy character. Sometimes it is confined to the forehead and 
temples; more often it extends over the whole head. The patient com- 
plains of a general lameness and an aching of the whole body. At first 
there is no marked change in the countenance. The patient's face wears 
a dull, listless expression ; it flushes towards evening as the temperature 
rises. He talks but little, is inclined to drowsiness, and is not easily 
aroused. In his sleep he is restless, being disturbed by unpleasant dreams. 
Exceptionally, slight delirium is manifested during the first week. Thirst 
is a prominent symptom; food is taken with reluctance. At first the 



TYPHOID FEVER. 867 

tongue is moist and covered with a light, white coat; afterwards the coat- 
ing is partially thrown off, leaving the surface red and smooth on the side 
and top, and more or less dry in the centre. Tremulousness of the tongue 
is sometimes observed. The mucous membrane of the throat is often red 
and swollen, and slight difficulty in swallowing is sometimes complained 
of. In many cases the bowels are at first confined ; ordinarily, diarrhoea 
does not occur until the second week, although in some cases it is present 
at the onset, and continues throughout the course of the disease. 

Towards the end of the first week the abdomen is somewhat swollen, 
and tender on pressure in the lower right side. When firm pressure is 
made in this region, a gurgling sound will be produced, and is sensible 
to the touch. This is one of the highly diagnostic symptoms of typhoid 
fever. It may not become prominent until the commencement of the 
second week. While the fever runs high, the urine is usually scanty and 
high-colored. Bleeding at the nose, which has been mentioned as an early 
symptom, occurs not infrequently after the prodromic stage. Generally 
the loss of blood is slight. If there is moderate hemorrhage from this 
source, the headache is usually somewhat relieved. Between the sixth and 
twelfth day from the commencement of the fever, there appears an erup- 
tion which is characteristic of the disease. It consists of single papules, 
scattered here and there, sometimes over the whole surface of the body, 
but more often limited to the chest and abdomen. They are only slightly 
elevated, and are of a rose or pink color, which momentarily disappears 
upon pressure. Scarcely more than fifteen or twenty of these spots 
appear; the eruption is not invariably present, but is seen in a very large 
proportion of cases. 

In the second week, the fever remains continuous, at about the same 
degree unless the disease progresses unfavorably, in which case the tem- 
perature rises above 104°. There are morning and evening variations, the 
difference being from one-half to one degree. Gradually the results of 
the continued high fever manifest themselves ; the patient loses flesh and 
strength, and the characteristic signs of the typhoid state are slowly 
developed. The face becomes pale or livid ; it is expressionless, and wears 
what is called a leaden or stupid look. The eye is dull and reddened ; 
the cheeks are usually flushed. The headache and other pains are no 
longer complained of; the patient is apathetic and seems to doze much of 
the time, but does not sleep soundly. When asked how he feels, he usually 
answers, " very well." Frequently there is ringing in the ears, and moder- 
ate deafness; in some cases, the hearing power is notably impaired. The 
desire for fluids is no longer expressed, but the patient drinks readily 
when they are offered him. As the mind is weakened and perception 
blunted, the tongue is protruded with difficulty, and apparent hesitation, 
only after repeated demands, and when protruded may not be withdrawn. 
The surface of the tongue is sometimes smooth or glazed. It often 



368 CONTINUED FEVERS. 

becomes bard and dry, and not infrequently is covered with a thick, 
brown coating. In severe cases, the tongue becomes cracked, deeply 
fissured, and colored by slight hemorrhages. Speech is difficult, and often 
unintelligible. Dark or black matter, called sordes, collects on the teeth 
and lips, forming crusts ; these are thick and abundant in grave cases. 

Exceptionally, delirium is manifested in the first week, but in the 
majority of cases it does not come until the second week of the fever. As 
Flint says : " Cases differ much as regards the degree of delirium ; it may be 
slight, or, on the other hand, a very prominent symptom. Generally, the 
first evidence of mental aberration is temporary confusion on awaking from 
sleep, the patient being unable to recall where he is, and asking incoherent 
questions. Increasing, the patient talks incoherently, and mutters like a 
person talking in his sleep. Efforts to get out of bed are common, and, when 
asked where they would go, patients often say they wish to go home. In 
most cases they are easily persuaded to lie down, but after a few minutes 
the effort to get up is repeated. If not watched, they sometimes get up, 
and succeed in getting on their clothes. The delirium is always greater, 
and may be manifested only, during the night. In the great majority of 
cases, it is of a quiet, passive kind. It apparently proceeds from weakness 
of the mind ; there is inability to carry on connected trains of thought. 
The incoherent talking or muttering usually relates to habitual pursuits. 
The patient is in a dreamy state, a succession of disjointed ideas passing 
through the mind." In some cases, there is a rapid transition from mild to 
violent delirium. Patients have keen known to suddenly spring from the 
bed and jump out of the window. 

The patient usually lies on his back, often for hours moving only his 
hands. In grave cases, the hands grasp at invisible objects, and pick at 
the bedclothes or body-linen. There are twitchings of the tendons of the 
wrist, called subsultus tendinnm, and not infrequently there are contrac- 
tions of the muscles of the face. Often the bowels are evacuated in the 
bed. The urine in some cases passes involuntarily ; in others it is retained, 
and, owing to blunted perception, the bladder may become greatly dis- 
tended. Generally, the swelling of the abdomen gradually increases dur- 
ing the second week, and in most cases there is more or less profuse diar- 
rhoea. Usually, there are at least from four to six discharges in twenty- 
four hours, — often more. They are light brown or yellow, and maybe 
thick or watery ; in exceptional cases, constipation exists throughout the 
course of the disease. Cough, while usually present, is not a prominent 
symptom, unless pneumonia occurs as a complication. In nearly all cases 
of typhoid fever, bronchitis co-exists in a subacute form. 

In the third week, the symptoms continue with undiminished intensity, 
or even increase. Typhoid runs a variable course. In many patients the 
symptoms which have been described as belonging to the second week 
are not fully developed until the third. In advanced and severe cases, 



TYPHOID FEVER. 369 

the patients become so weak they are unable to change their positions, and, 
slipping oft' the pillow, they lie in a relaxed condition at the lowest part of 
the bed. Often they are insensible to that degree that they can no longer 
be aroused. More marked remissions of fever are now observed; the tem- 
perature is lower in the morning, but at night it reaches about the same 
height as during the second week. It is estimated that in about one in 
twenty cases hemorrhage from the bowels occurs, and it may vary from a 
mere trace of blood to a discharge of a pint or more. Profuse hemor- 
rhages are due to the opening of an artery in some of the intestinal ulcers 
which characterize the disease. They more often occur in the latter part 
of the second, or during the third week. When the loss of blood is con- 
siderable, it is accompanied by extreme prostration, and a sudden fall in 
the temperature. There may be but a single hemorrhage, but more often 
there are a greater or less number of recurrences. The blood is usually 
fluid, rarely clotted, and generally of a bright red color. Hemorrhages 
from the bowels are more frequent in severe cases that have been attended 
with profuse diarrhcBa. It is during the third week that most of the com- 
plications are developed — especially the affections of the lungs, and bed- 
sores. 

The fourth vieek, there is a general improvement in all the symptoms, 
The fever subsides, the temperature falling lower and lower each night, 
until, by the end of the week, the normal standard has been reached. The 
cloud upon the patient's brain seems to slowly lift, as it were ; he is less 
drowsy, is more rational, and soon appears interested in what is going on 
around him. His sleep is more natural and refreshing, and, while somewhat 
confused on waking, his mental faculties soon become clearer. The control 
over the bowels and bladder is regained ; the discharges are less frequent, 
darker, and thicker. Thickness of speech soon disappears, as the tongue 
becomes more moist and movable. The sense of taste is renewed, and the 
appetite slowly returns. The face, while pale and thin, is no longer livid, 
but has a more natural expression. Emaciation, even in cases of moderate 
severity, is always marked. Profuse sweatings are not infrequent as the 
fever declines. During the period of convalescence, the patient's gain is 
usually rapid ; the return of the fever is, however, easily induced by errors 
in diet, and undue mental and bodily exertion. If a favorable course is 
pursued, recovery is usually rapid. 

Causation. It is universally accepted that typhoid fever is developed 
from a special cause, which is capable of producing this disease and no 
other. What the nature of this cause is, whether it is a germ or not, has 
not been definitely determined; there is reason to believe that it is a form 
of organism called bacillus. It is assumed that the germs which produce 
this disease, and which are certainly contained in the discharges from the 
bowels of typhoid fever patients, gain entrance into the system through 
the air, coming from places into which such discharges have been depos- 



370 CONTINUED FEVERS. 

ited, or through water contaminated by a similar process, or through milk 
diluted with contaminated water, or perhaps vitiated by contaminated air. 
Many believe that, no matter how polluted the drinking-water or air, this 
disease cannot be developed unless the germs derived from the intestinal 
discharges oi patients affected with typhoid fever are present. In the 
existing state of knowledge, the correctness of this theory cannot be con- 
sidered as established. Considering the fact that outbreaks of the disease 
have occurred in situations where previously typhoid fever was unknown, 
it is believed by many that, under favorable conditions, the germs which 
produce the disease may be developed spontaneously — that is, without 
being derived from a pre-existing case. This question of spontaneous 
origin has strong advocates on both sides, but, reasoning by analogy, it is 
fair to assume that the germs always do come from a typhoid-fever patient, 
and that vegetable or animal decomposition alone is not sufficient for the 
development of the disease. 

It seems to be well established that the germs enter the system in two 
ways, — in the drinking-water, or other liquid mixed with water, and by 
the inspiration of contaminated air. The conditions favorable to the 
reception of the germs and to their development are found in privy-vaults, 
drains, cesspools, and in all situations in which decomposing animal and 
vegetable matter abounds. There the germs are propagated, and thus 
become the infecting agents when individuals are brought within their 
influence. In recent discharges from the bowels of typhoid-fever patients, 
the germs are not active, and the disease is not carried directly from one 
person to another. Those who are in attendance upon patients ill with 
typhoid fever are, at the time of service, in no way exposed to the disease. 
After leaving the body, there remains a stage of development through 
which the germs must pass. The necessary change may take place in the 
discharges themselves, but it goes on very rapidly in privies, or in earth 
that is already saturated with impurities. 

Facts have shown that the typhoid germs have great vitality, and retain 
their infecting power for at least two years. Loomis says typhoid 
fever frequently occurs in the same locality year after year, when the sur- 
rounding conditions are favorable to its development. These conditions 
are more frequently present in the autumn than in any other season of the 
year, and for this reason it lias been called the autumnal fever. Usually, 
it makes its appearance in a locality each year at about the same time ; 
case after case is developed, until whole households and entire neighbor- 
hoods become its victims. Individuals who come to care for the sick may 
contract the disease, and even persons who visit houses in which the dis- 
ease is prevailing may afterward develop the fever, contracting it, not from 
the sick, but from the infected atmosphere of the locality. After the germs 
are introduced into the body, the symptoms of the disease are usually man- 
ifested in about two weeks. Those who have suffered from one attack 



TYPHOID FEVER. 371 

rarely experience another, yet it is not impossible for them to do so. The 
disease occurs most frequently between the ages of fifteen and twenty-live, 
and is rarely observed in persons over fifty. 

Prognosis. The older physicians were wont to say that typhoid fever 
was a disease which, more than all others, mocked medical foresight, 
and intimated that any prognosis whatever was practically impossible. 
Death may occur in any stage of the disease ; in uncomplicated cases, it 
most frequently happens towards the end of the third or in the beginning 
of the fourth week. There are wide differences in the rate of mortality at 
different periods and places. Doubtless among all those who are attacked 
by the disease one in six dies. According to Flint, as regards age, Mur- 
chison's statistics show the lowest rate of mortality to be from ten to fif- 
teen years, and the next lowest from five to ten years, the number of cases 
analyzed under five years being insignificant. The highest rate under fifty- 
five years is from thirty to thirty-five years. Jackson's statistics show the 
death-rate to be greater above than below thirty years of age; and they 
show a greater mortality in the cold than in the warm months. It is a 
matter of common observation that vigorous persons are more likely to 
succumb than those of feeble constitution. 

Many fatal results are attributable to hemorrhage and perforation of 
the intestine. The former occurs in from five to eight per cent of the 
cases, and, while a very grave symptom, it is not necessarily fatal. All 
special brain-symptoms, such as subsultus, picking at the bedclothes, etc., 
are ominous. Cases in which the delirium is continuous and well marked, 
or occurs at intervals, in the form of violent fits of excitement, usually end 
fatally. The condition of the heart's activity is one of the most important 
prognostic signs; weakness or paralysis of that organ is the most frequent 
immediate cause of death. If the pulse becomes extremely rapid and 
feeble, the prognosis is unfavorable. When the temperature rises to 105° 
the danger is great; an increase of two or more degrees above that point 
is a fatal sign. The prognosis is measurably influenced by the duration of 
the fever, especially the duration of the second stage, in which there are 
but slight remissions of fever ; the danger to the patient increases with 
every additional day which it lasts. Great prostration is extremely unfa- 
vorable. Diarrhoea, severe and persistent, soon exhausts the patient. The 
presence of dark-colored incrustations on the mouth and tongue are of 
grave importance. Intestinal hemorrhages, while not necessarily fatal, 
always denote gravity. They are generally accompanied by a sudden fall 
in the temperature, great prostration, and an increase in the rapidity of the 
pulse. If these signs appear during the second or third week, it is very 
conclusive evidence that intestinal hemorrhage has occurred, although 
blood may not have been discharged from the bowel. Excessive abdominal 
distention and pain in that region are unfavorable symptoms. Recovery 
rarely follows intestinal perforation. When corpulent persons are attacked 



3 . - CONTINUED FEVERS. 

with typhoid fever, they are more endangered by the disease than the lean, 
or even weak and ill nourished persons. The fatality is greater among 
drunkards. In no other disease lias judicious nursing a greater influence 
on prognosis. 

During the convalescent stage of typhoid fever, not infrequently 
relapses occur. All the prominent symptoms of the primary attack are 
rapidly developed, and the course which is pursued, while shorter, corre- 
sponds with that previously experienced. The causes of relapses are not 
always obvious ; not infrequently, however, they can be traced to indis- 
cretion in diet, over-exertion, and similar influences. While the severity 
of the second attack is usually greater than the first, a fatal termination is 
comparatively rare. 

Treatment. Before entering upon the specific treatment, it will be 
well to consider what measures it is essential to employ in the prevention 
of typhoid fever. Accepting the theory that the specific poison of the 
disease is contained in the discharges of typhoid patients, the first indica- 
tion to secure safety from infection is to destroy this poison as soon as it is 
expelled from the body. For this purpose a porcelain bed-pan should be 
used, the bottom of which should be covered with a layer of powdered 
sulphate of iron each time before being used. Immediately after the pas- 
sage, crude muriatic acid, equal in quantity to one-third or one-half of the 
discharged mass, should be poured over it. The contents of the bed-pan, 
no matter how thoroughly disinfected, should never be emptied into privy- 
vaults or water-closets, if they can be disposed of in trenches dug anew 
every few days, and filled when discarded. The greatest care should be 
taken that these trenches are so located that the drainage from them can- 
not contaminate wells and springs which furnish drinking-water. All the 
underclothing or bedclothing that may become soiled by the discharges from 
the bowels should be immediately immersed in a solution of the chloride 
of zinc, or in chlorine water, and thoroughly boiled within twenty-four 
hours. Liebermeister states that he has employed this same method with 
cholera patients who were admitted to the hospital, exercising the same 
care with matters vomited, and no spread of the disease ensued. He gives 
the fullest guaranty that no extension of the malady will ensue from a 
single case, if these precautions are observed. Many physicians in America 
consider the cheapest and best disinfectant to be a solution of corrosive 
sublimate. They also hold that, while the stools are not infectious imme- 
diately after being passed, experience has shown that they become so after 
the lapse of twelve hours. 

One essential point in the special treatment of typhoid fever is that the 
patient should be put to bed at a very early period, and kept there until 
convalescence is established. If symptoms of the disease appear, even 
while insufficiently pronounced to render a positive diagnosis possible, the 
patient should at once take to his bed, and 'there remain until all doubts 



TYPHOID FEVER. 373 

are removed. When there is sufficient reason to believe that the attack is 
typhoid, the most rigid discipline should be enforced. The sufferer musl 
retain a horizontal position, and under no circumstances be allowed to -it 
up until the dangers are past. The linen should be changed without his 
leaving the bed, and all efforts, such as raising himself on his elbows t<> 
drink, be strictly prohibited. Too much stress cannot be laid upon this 
point, even in the wildest cases, as by disregarding this most important 
rule many lives have been sacrificed. All know how thin the intestinal walls 
are in their normal state. When ulceration occurs in them, they become 
weakened, and rupture easily. Even the effort required in leaving the bed 
to sit on a chair, or to answer the calls of nature, is sufficient in some cases 
to rend the walls, thinned by disease, and death almost inevitably results 
from this perforation. Therefore a bed-pan and drinking-tube are the first 
essentials for a typhoid-fever patient. Not infrequently will be encoun- 
tered some who will obstinately refuse to use the former; they will main- 
tain that it is positively impossible for them to do so. This is mere 
caprice — nothing more; and attendants must insist upon its employment. 
If they do not do so, they violate their trust, and, if the patient dies, they 
may know that by their own neglect they have contributed to the unhappy 
end. If a patient will not use the bed-pan, then thick brown paper, covered 
with a cloth, should be substituted. There is one important fact to remem- 
ber — that laxatives are never to be administered, excepting when ordered 
by a physician. Seldom, if ever, will their use be warranted. 

It is desirable that the sick-room be large and well ventilated, and two 
beds should be provided for the use of the sufferer ; he can be gently 
moved from one to the other, when necessary. The carpet should be 
removed, also all furniture, excepting those articles absolutely essential to 
comfort and convenience. The apartment should be kept perfectly quiet, 
the light subdued, and the temperature below 60°; only the attendants 
should be allowed in the room. If practicable, it is advisable that the bed 
and body linen be changed daily, and at once placed in a weak solution of 
chlorinated soda. Fresh air, during both day and night, is of the utmost 
importance. 

Among the ancient absurdities occasionally encountered at the present 
time is the belief that the use of water is hurtful in fevers. Not only 
should patients be allowed to take it as freely as they may desire, but it 
should be systematically given throughout the stage in which the intellect 
is clouded, and they are unconscious of their needs. It has been said that 
there is reason to think that death is sometimes attributable to an insuf- 
ficient supply of liquid. Ice-water is not objectionable, and will assist in 
no slight measure in controlling the fever. If agreeable to the patient, 
lemon or orange juice may be added ; the quantity of the acids should, 
however, be small. In mild cases of typhoid fever, medicinal measures are 
unnecessary; judicious nursing and proper dietetic treatment will prove 



374 CONTINUED FEVERS. 

sufficient. Milk, alone or with lime-water, is the most suitable food; 
fruits are not to be allowed in any case. It is desirable that from one to 
two quarts of milk at least be taken daily. Many patients will drink much 
more than this quantity; any reasonable desire for it may be gratified. 
There is no objection to giving beef-tea, and, if properly prepared, it is 
nutritious and palatable. Mutton and chicken broth are also allowable. 
Coffee and tea. with an excess of milk, are pleasing additions to the diet. 

Regarding the importance of support in typhoid fever, Graves gave 
expression to an important truth when he said that a great object of treat- 
ment is to prevent patients from dying of starvation. In severe cases of the 
disease. Flint likens the situation of the patient to that of a person in danger 
of drowning not far from, or perhaps very near, the shore ; if he drown, it is 
because his strength gives way before the shore is reached. As a person in 
this situation only requires to be buoyed up by some support, so the fever 
patient, in a similar emergency, may need only supporting measures to live 
until the disease ends. Death may take place at a juncture when, could it 
have been averted a few days, or, perchance, even a single day, the period 
of danger might have passed. 

As previously stated, in mild cases of typhoid fever no medicine is 
necessary. It is a se;f-limited disease, and if the patient is properly nursed 
and supported, and no serious complication occurs, recovery may be 
expected after three or four weeks. In this connection it may be said that 
physicians frequently hear patients tell of former experiences in attacks of 
tyjjhoid fever, which had been "broken up" by some marvellously skilled 
disciple of the healing art. These credulous people are simply victims of 
dishonest practitioners, for the disease in question cannot be aborted. 

The writer feels that it is his duty to limit the discussion of the treat- 
ment of typhoid fever to those points he has already dwelt upon. In 
every case, either mild or severe, a physician should be in attendance ; his 
assistance is simply indispensable. All should appreciate this fact, and 
under no condition assume the responsibility of alone caring for a typhoid 
patient. For those who are suffering from the malady, danger lurks 
throughout its course. As Liebermeister says of the duties of a physician, 
he must see to it that the usual incidents of the disease, if they show a 
tendency to grow especially burdensome or dangerous, as well as any sus- 
picious accidental developments, are held within check, and, so far as pos- 
sible, weakened in their power. He must strive to maintain the patient in 
such a condition that he shall be able to offer the longest and the strongest 
resistance to deleterious influences of which his constitution is capable. 
<; Our endeavor is no longer, like that of the mariners of old, to appease 
the fury of the storm-god by offerings and by prayer: it is enough for us 
if we keep our good craft seaworthy, and steer her safe 'mid rocks and 
quicksands; the storm will cease without our bidding, when once its fury 
is spent." 



TYPHUS FEVER. 375 

TYPHUS FEVER, 

The fever called typhus lias received a great variety of names, such as 
ship fever, camp fever, spotted fever, Irish ague,, etc. It is a contagious 
disease, and while the immediate cause which induces it is unknown, there 
is reason to believe in the existence of a specific germ. It is generally 
accepted that this germ or poison is present in the emanations from the 
bodies of patients suffering from the disease, and to become infected it is 
necessary to be brought in contact with them, or within an atmosphere 
impregnated with their exhalations. Loomis says : " The distance that 
typhus poison can be transmitted through the atmosphere would seem to 
be limited. It has been proved by actual experiment that the contagious 
distance of small-pox, in the open air, does not exceed two and one-half 
feet, and it would seem that the contagious distance of typhus fever is 
even less. Typhus poison is undoubtedly present in the body exhalations 
and the expired air of typhus-fever patients; but it requires a concentra- 
tion of the poison to render it infectious. Slight exposure is not sufficient ; 
it requires a concentrated poison and a prolonged exposure. The more 
numerous the typhus-fever patients are, the more powerful does the conta- 
gion become ; yet a single exposure even to such an atmosphere is rarely 
sufficient to develop the disease in an individual who is in good health at 
the time of the exposure." It is believed by many that the disease may 
be communicated by infected clothing, but the same must be well impreg- 
nated with the poison. 

The prodromic stage of typhus fever is usually short, and in the 
majority of cases patients take to their beds on the second or third day 
after the first signs of illness are manifested. The symptoms which pre- 
cede an attack are a feeling of indisposition, restlessness at night, more or 
less severe pains in the head, neck, and limbs, vertigo, loss of appetite, 
nausea, and sometimes vomiting. The actual beginning of the disease is 
usually characterized by a short chill, which may be repeated at intervals 
during the following days. Fever exists at the outset, and rapidly grows 
intense ; the temperature within twenty-four hours may rise as high as 
105° or 106°. The skin is burning hot, the face and eyes are reddened, 
and the cheeks swollen. The headache is severe and constant, and is 
usually associated with dulness and confusion of the mind ; patients com- 
plain of feeling dizzy on sitting up or on leaving the bed. The pains in 
the back, limbs, and especially in the thighs, are more severe than in 
typhoid fever. The loss of muscular power and a feeling of extreme pros- 
tration are very pronounced in the early stage. The tongue at the outset 
is covered with a white coating, which, after a day or two, becomes thicker 
and assumes a yellowish brown color. 

The symptoms referable to the nervous system are essentially the same 
as observed in typhoid fever; they occur earlier, however, in the career of 



CONTINUED FEVERS. 

typhus. The expression of the countenance is dull and apathetic, the 
movements tremulous, and while answers to questions are generally cor- 
rect, the patient soon after being aroused becomes indifferent again, or 
falls into a drowsy condition. Sleep is disturbed, and when awake the 
mind of the patient is confused ; in severe cases delirium is present at an 
early stage. 

As the disease progresses, the distinctive differences between typhoid 
and typhus fever become plainly evident ; the abdominal symptoms, 
diarrhoea, distention, gurgling, and tenderness, highly diagnostic of the 
former, are all wanting in the latter. The abdomen is soft and free from 
pain; the bowels are almost always constipated. Towards the close of 
the second week the characteristic eruption appears. This consists of 
dirty pink colored spots, which are slightly elevated above the surface, and 
for a few days they disappear on pressure. These are first observed on 
the sides of the abdomen, and gradually they extend over the whole an- 
terior portion of the body, except on the face and the palms of the hands. 
After a day or two these spots become of a dull, dingy red or purplish 
color ; they are no longer elevated, and cannot be made to readily disap- 
pear on pressure. They remain visible throughout the disease, and are 
often apparent after death. 

The typhoid symptoms observed in the first become more marked at 
the beginning of the second week. The impairment of the mental facul- 
ties is very pronounced ; all special senses are blunted, and the patient 
lies in a condition of stupor, wearing the look of extreme prostration. 
Especially noticeable in the face, there is a dusky dingy hue of the skin 
which is distinctive of typhus as compared with typhoid fever. The 
delirium is said to vary in character and severity in different epidemics, 
being much more violent and active in some than in others. Contraction 
of the pupil of the eyes, called by Graves the pin-hole pupil, is sometimes 
noted during the delirium or stupor. The general symptoms which are 
present in the second week of typhus so closely resemble those of typhoid 
fever that their description is unnecessary. In the former, however, 
symptoms referable to the abdomen are entirely absent, and there exist 
none of the ulcerative changes in the intestine, and attendant dangers, 
which are so characteristic of the latter. The odor of the typhus patients 
is said to be characteristic ; it is peculiar, and none have been able to 
define it. 

Typhus fever runs a shorter course than its relative, typhoid. If the 
case tends to recovery, there is an improvement in the symptoms between 
the tenth and fourteenth day. The patient falls into a quiet, refreshing 
sleep, and awakes to consciousness as from a dream. The skin becomes 
cooler and moist ; the pulse falls, the tongue cleans, and there is a desire 
for food. Within a few days convalescence is established, and recovery, 
while slow, is much more rapid than in typhoid fever. The mortality 



TYPHUS FEVER. 377 

varies in different epidemics. It may be said that to one out of every six 
or seven attacked with the disease it proves fatal. 

All authorities agree upon the importance of fresh air in the treatment 
of typhus fever. They consider it advisable, even in the severest weather 
in winter, to keep the windows open or to remove them altogether, suffi- 
cient clothing being used to keep the patient warm. When epidemics 
occur during the summer, they consider that treatment in tents promises 
by far the best results. The general principles in the management of 
typhus and typhoid fever are essentially similar. Careful nursino- and 
properly applied supportive measures are of greater importance than 
medicinal agents. 



SECTION VII.— III. 

EKUPTIVE FEVERS. 



CHAPTER I. 

SMALL-POX. 



Uxder this head are included variola and varioloid, two forms of erup- 
tive fever which differ only in regard to the severity of the symptoms. 
Vaccination in the great majority of cases destroys for a certain period 
the susceptibility to small-pox. While it does not always afford complete 
protection against that disease, it notably diminishes its severity. The 
modified form which occurs among those who have been inoculated is 
called varioloid. The practice of vaccination has now become so uni- 
versal, the occurrence of variola is comparatively rare, and epidemic 
prevalence of either form of this eruptive fever is now no longer to be 
apprehended. 

Small-pox is a highly contagious disease, which, as at present believed, 
is disseminated exclusively by means of a specific virus, generated within 
the body of a patient suffering from the disease. This poison can be 
communicated from one person to another by means of the breath and 
exhalations from the skin. It is readily transported by means of clothing 
and other objects which have been used by small-pox patients, or have 
been in their immediate vicinity. When excluded from the air the poison 
retains its vitality for a long time ; the duration of its contagiousness has 
been estimated at many months and even years. A very transient and 
slight exposure often suffices for the production of the disease. 

The length of time which elapses after the exposure to and recep- 
tion of the variola poison, before the outbreak of the disease, is, in the 
majority of cases, from ten to fourteen days. The so-called stage of inva- 
sion is that period of fever and disturbance of the general system which 
precedes the outbreak of the eruption. Its duration, as a rule, is two 
days ; occasionally it is extended to the fourth or fifth day, and in rare 
instances even longer. The usual symptom which marks the beginning of 
this stage is a chill, more or less severe. Occurring simultaneously with 
it, or preceding it for a few hours, there is pain in the head and back 

378 






SM ALL-POX. 870 

especially in the middle of the back and loins. Nausea is also present, 
and soreness of the throat is often a prominent symptom. The patients 

are languid and weak in proportion to the severity of the attack ; they 
complain of constant thirst, the lips and tongue appear much parched; 

the latter is usually covered with a thick whitish yellow coat, and there i^ 
an offensive odor to the breath. There is almost always 1 « > t : 1 1 loss of 
appetite. Pain is felt in the pit of the stomach, and in that region 
there is tenderness on pressure. The bowels are usually constipated, but 
diarrhoea is sometimes present. During this stage the rise of the fever 
is usually progressive until the eruption appears: It is accompanied with 
sweating; the pulse is rapid, the face flushed, the eyes reddened, and there 
is throbbing in the large arteries of the neck. In the severer eases of the 
disease, delirium may be manifested on the second or third day. Nearly 
all patients suffer from great restlessness and sleeplessness; many complain 
of extreme vertigo. The group of symptoms thus far described may be 
greatly modified in certain cases. Some of them may be entirely absent, 
while others may appear with special severity. The fever may be intense 
or of the mildest character. In very rare instances the disease terminates 
with the stage of invasion. 

Generally on the third day of the disease an eruption makes its appear- 
ance, first on the face, especially along the edges of the hair. It appears 
in the form of pale, red spots, slightly elevated, and varying in size from a 
millet-seed to a pin's head, or even larger. These spots much resemble 
flea-bites. The forehead, eyes, nose, and upper lip are usually covered 
first. They gradually increase in size, the increase being attended with a 
sensation of slight burning and itching. Usually some hours later the 
eruption appears upon the neck and wrists, next on the chest and arms, 
then over the body, and last on the lower extremeties. From one to 
three days pass before the spots are fully exhibited. On the second day 
of the eruption, and the fifth day of the disease, the spots assume a 
darker red color ; they enlarge in diameter, and the central part becomes 
hard, slightly elevated and pointed. They are now distinct papules, and 
feel like small shot under the skin. On the appearance of the eruption 
the febrile symptoms subside, and pain in the head and back is no 
longer complained of. Small papules are also seen in the mouth and 
pharynx. 

On the third day of the eruption, the papules, having become more 
conical, present at their summits little vesicles filled with a clear opaline 
fluid. These continue to enlarge until on the fifth day of the eruption 
they have attained to nearly or quite their full development, and are then 
about the size of a pea. During their enlargement a central depression 
forms in a greater or less number of these vesicles. They are then said 
to be wnbilicated, and this appearance is highly characteristic of the dis- 
ease. 



380 ERUPTIVE FEVERS. 

About the sixth day of the eruption, the so-called stage of suppuration 
is entered. The contents of the vesicles which have been growing turbid 
now become purulent, and by the eighth day pustules are fully formed. 
Around the base of each pustule the skin is reddened and swollen. The 
face swells to a shapeless mass, and the patient becomes absolutely 
unrecognizable. The eyes are closed, the feet and hands look, as has been 
said, like round balls. The itching now becomes intolerable, and with the 
accompanying burning pain renders the sufferings of the patient intense. 
During this period a characteristic sickening stench is emitted. With the 
change of the eruption to pustules there is a recurrence of the febrile 
symptoms, constituting what is known as the secondary fever. This is 
sometimes ushered in by a chill or by repeated chills, and continues from 
six to even eight days according to the severity of the case. Sweating 
now ceases ; there is great restlessness, sleep is denied the sufferer, the 
headache returns, and, in severe cases, delirium occurs; although more 
often the delirium is passive like that generally noted in typhoid fever, it 
sometimes becomes active and maniacal, the patient even requiring the use 
of a straight-jacket. 

The so-called stage of desiccation, or the drying of the pustules, com- 
mences about the twelfth day of the disease. The drying process is first 
noted in the face, in those pustules which first appeared. The redness and 
swelling of the skin lessen, and the countenance begins to assume a more 
natural appearance. The fluid exuded from the pustules forms firm and 
small brownish scabs, which are at first quite firmly adherent to the 
surface. About the fourteenth day of the eruption, these scabs become 
separated, leaving reddish brown stains beneath, which remain visible for 
five or six weeks. As the drying stage is entered, the febrile symptoms 
begin to subside, and have entirely disappeared when the crusts fall. The 
appetite then returns, and the patient is able to sleep, and convalescence is 
fully established. 

Thus far the symptoms of the severer form of small-pox or variola 
have been described. It remains to briefly consider some of the varying 
phases of its milder relative. Varioloid is more rapidly developed, runs 
a milder course, and is of shorter duration. The period between exposure 
and the outbreak of the disease is about one-half as long as in variola. 
The eruption is far less abundant, and may be limited to a few pocks even 
to a single pock. It passes rapidly through the successive changes; vesi- 
cles often form within twelve hours. Frequently these abort, and those 
which become purulent are complete pustules on the third day. On the 
fifth clay the drying stage commences, and is often completed by the 
seventh day. In varioloid there is but little constitutional disturbance 
after the appearance of the eruption, and secondary fever is very slight 
or absent. It is only during the period of invasion that this mild form 
may be said to closely resemble variola. 



CHICKEN-POX. 381 

The hemorrhagic form of small-pox, called the black or malignant 
small-pox, is but a modification of other varieties. It is usually developed 
in from six to eight clays after exposure, and the symptoms in the staoe of 
invasion do not materially differ from those already described, excepting 
that the fever is more often exceedingly violent. When the eruption 
appears, the hemorrhagic tendency is not infrequently manifested by the 
dark color which the spots assume. In some cases this tendency is not 
apparent until vesicles are formed, in others not until the stage of 
suppuration is reached. Very few cases of this form of small-pox 
recover. 

The general treatment of small-pox involves the same principles as con- 
tinued fevers. The disease cannot be arrested, nor its severity mitigated, 
after the stage of invasion is entered. Cold drinks are to be allowed as 
freely as the condition of the stomach will permit. If the headache is 
severe, the application of ice affords relief. Opium is needed if there is 
great restlessness. If there is persistent vomiting, drinks must be restricted, 
and cracked ice given. For nourishment, ice-cold milk and lime-water, or 
milk and seltzer-water, are the most easily borne by the stomach. If the 
fever is intense, frequent sponging with cold or tepid water will tend to 
reduce it. Constipation should be relieved by injections. Pure air, as in 
typhus or typhoid fevers, is of infinite importance. In the severer forms of 
the disease, stimulants are often demanded, and should be used freely, if 
the patient is found to be sinking. During the drying-off stage, warm 
baths afford great comfort; after their employment, the surface of the 
body should be freely oiled. The pitting cannot be obviated by any known 
means ; cold-water dressings applied over the face, after having carefully 
evacuated each vesicle, afford great comfort, relieving to a certain extent 
the intense itching, and thus limiting the tendency to scratch. 

CHICKEN-POX. 

Varicella, or, as it is commonly called, chicken-pox, is an eruptive dis- 
ease, affecting, for the most part, children, but occasionally adults. It is 
an acute contagious affection, running a mild course, without distressing 
symptoms, and always tending to recovery. The name varicella, which is 
a diminutive of variola, meaning little small-pox, implies that the disease 
is essentially variolous. The non-identity of the two affections seems 
clearly established. 

The first symptoms of chicken-pox are manifested in from ten to fifteen 
days after exposure. For twenty-four hours preceding the eruption, 
there are usually slight constitutional symptoms, consisting of slight fever, 
lassitude, and a feeling of malaise. The eruption appears first on the back, 
and afterwards on the head. It then spreads irregularly over the abdomen 
and extremities. It is vesicular from the first, consisting;' of little blisters 



882 ERUPTIVE FEVERS. 

filled with a clear, watery fluid. Now crops of vesicles appear on the sec- 
ond and third days; generally, they arc attended with slight itching. 
Between the fifth and seventh day, a drying-up process occurs, and small 
crusts arc formed, which soon become separated. 

In many cases of chicken-pox no treatment is necessary. If there is 
notable constitutional disturbance, it will be well to confine the patient to 
the bed for a few days, give cooling drinks, and restrict the diet to 
unstimulating food. 



CHAPTER II. 

SCARLET FEVER. 

Scarlet fever, or scarlatina, derives its name from the bright red 
appearance of its eruptions. It is essentially a disease of childhood, but 
may occur in any period in life, and for that reason it is considered 
in this work. As has been said, "the disease is remarkable for the 
wide diversity which it presents, in different cases, as regards symptoms 
and fatality. In its mild form, it is a trivial affection ; in it severest form, 
there are few diseases more appropriately styled malignant." 

It is indisputable that the cause of scarlatina is a specific poison, which 
is contained in the emanations of a patient suffering from the disease. It 
is assumed that it is present in both the expired breath and the exhalations 
from the skin, thus infecting the air of the sick-room. The contagious 
poison can be transmitted through the medium of clothing, and substances 
which have been within this morbid atmosphere. That the disease is 
eminently contagious is a fact recognized by all, and that unaffected 
individuals who have been in contact with, or in the presence of, per- 
sons sick with scarlet fever may communicate the disease through the 
medium of their clothing, is also indisputably proved by numerous exam- 
ples. Thus, Richardson attributes the infection and death of a child and 
its mother to a letter which the former had conveyed to the latter from a 
house several miles distant in which scarlatina had prevailed. Thomas 
tells of a case in which a nurse coming directly from a scarlatinous patient 
gave the disease to a child who had almost recovered from tracheotomy. 
Maclagan saw a case in which the medium of communication was a woollen 
shawl in which a scarlet-fever patient had been wrapped. An instance is 
recorded in Massachusetts where there was good reason to believe a physi- 
cian carried the contagious poison in his clothing from one patient ill with 
the disease to another, a woman soon to become a mother ; the latter died 
in one week after confinement. In one instance, Mason Good thinks that a 
box of toys was the means of transportation. The shortest contact with the 
contagious atmosphere of the sick-room may suffice for infection. Accord- 
ing to Palante, a mother, after remaining only a moment with a scarlati- 
nous patient, immediately returned home, a distance of about six miles, yet 



384 ERUPTIVE FEVERS. 

communicated the disease to her children, in whom it developed some 

days later. Similar examples of the transportation of contagion from 
infected houses by healthy individuals might be multiplied, but a sufficient 
number have been cited to show the facility with which the poison is 
conveyed. 

The first symptoms of scarlet fever are usually manifested in from two 
to five days after exposure. The attack may commence with a chill, but 
more often it is wanting. Vomiting generally occurs as an early symp- 
tom, especially in children; bleeding at the nose is not uncommon. In 
severe eases the face is flushed, the skin dry; there is considerable exhaus- 
tion, heaviness in the limbs, malaise, and not infrequently high fever. 
There is often headache, with giddiness, mental dulness, restlessness, and 
drowsiness. Diarrhoea sometimes occurs, but usually it is not troublesome. 
There is loss of appetite, and the tongue is thickly coated. In mild cases, 
these svmptoms are so slight as to attract but little attention. In the 
majority of cases, there are present throat symptoms, which are very charac- 
teristic. These may assume prominence even before the eruption appears. 
Adults and older children often complain of a prickling sensation in the 
region of the tonsils, or pain in swallowing, and stiffness of the neck. The 
whole posterior part of the mouth, palate, and throat is usually reddened 
and swollen. In a proportion of cases, these symptoms are altogether 
absent at first, and do not come on until later in the disease. 

Generally, on the second day the eruption makes its appearance. In 
some instances, it is first seen on the face and neck ; oftener, however, it 
appears first on the body and limbs. It extends rapidly over the whole 
body, and on the third or fourth day reaches its full development. First 
appearing as little red spots, the eruption eventually involves the entire 
surface, and in previously healthy and well nourished children, if the dis- 
ease is severe, there is presented an intense uniform scarlet red, the 
patient being in the true sense of the term as red as a "boiled lobster." 
The eruption is accompanied by more or less burning and itching. 
The skin is very hot, generally dry, sensitive to the touch, and slightly 
swollen. The tongue presents a characteristic feature, which is quite dis- 
tinctive of scarlet fever; it is red. smooth, and dotted with little points, 
the appearance being strikingly like that of a ripe strawberry. As thy 
eruption progresses to its full development, the affection of the throat 
increases, and the tonsils, which are enlarged, are covered with a yellowish- 
white exudation, in greater or less abundance, or even with a true diph- 
theritic membrane. The glands of the neck at the angle of the jaw are 
frequently swollen and tender. The febrile disturbance, as a rule, is 
increased after the appearance of the eruption. The temperature often 
rises to 105°, and in severe cases a still greater increase is noted. The 
pulse varies much in different cases ; even in those which pursue a favor- 
able course it frequently reaches one hundred and forty beats per minute. 



SCAKLET FEVER. 385 

During the stage of eruption, there is total loss of appetite; vomiting 
may occur, but more often it ceases with the stage of invasion. Thirst is an 
urgent symptom. There is more or less severe headache and restlessness, 

and, excepting in very mild cases, delirium is commonly present, at leasl 
during the night. The kidneys are almost always involved in the inflam- 
matory process, as shown by the scanty, concentrated, and high-colored 
urine. 

Generally, between the fifth and sixth day of the eruption the fever 
begins to abate, and at the same time the eruption fades, with some 
rapidity; frequently by the end of the eighth day it is no longer visible. 
After the disappearance of the rash, desquamation, or the scaling-off pro- 
cess, commences. The fever continues to diminish, and gradually ceases. 
The throat symptoms subside; there is no longer difficulty or pain in swal- 
lowing, or swelling of the glands of the neck. The degree of desquama- 
tion is proportionate to the intensity and diffusion of the eruption. The 
skin is exfoliated in the form of minute, thin, branny scales, excepting on 
the palms of the hands and soles of the feet, where the skin is thick. In 
such situations it peels off in extensive patches. The process is frequently 
accompanied with itching, which in some cases is excessive. During the 
stage of desquamation, the tongue becomes moist, the appetite returns, 
sleep is quiet and refreshing, strength is renewed, and, in from ten to 
twelve days after the eruption begins to fade, in uncomplicated cases, con- 
valescence is generally complete. 

As previously stated, scarlet fever is remarkable for the wide diversity 
which it presents in different cases, and its symptoms may present every 
variety, from the mildest to the most severe character. In some cases, the 
throat affection is absent, or very trifling; in others, the tonsils are greatly 
swollen, and swallowing h so obstructed and difficult, liquids taken into the 
mouth are returned through the nose. The inflammation may involve the 
nasal passages, and extend up the Eustachian tube to the middle ear, and 
then follow destructive changes, which not infrequently result in perfora- 
tion of the drum of the ear and permanent deafness. Occasionally are 
met cases of unusual mildness, in which there is but little fever; the erup- 
tion is very scanty and poorly developed, and limited to certain parts of 
the body; other and associate symptoms are equally insignificant. Certain 
cases are characterized by extreme gravity of the symptoms at the outset 
of the disease. There is a tendency to stupor and delirium, great restless- 
ness, picking at the bedclothes, convulsions, and other evidences of serious 
brain-disturbance. Sometimes, on the other hand, these so-called malig- 
nant cases begin in a mild manner, and then, after the disease has pro- 
gressed for a time without the slightest occasion for alarm, symptoms sud- 
denly arise of the most dangerous character, and death speedily ensues. 
Sometimes, instead of declining with the eruption, the throat affection 
grows more severe, and diphtheria is developed. Among the most impor- 



ERUPTIVE FEVERS. 

taut irregularities is the hemorrhagic form of the disease, which almost 
invariably proves fatal.. The varied phases which arc- presented by scarlet 
fever arc almost numberless, and to discuss them all would be impossible 
in a genera] work of this character. 

This disease has various sequels; the one which is the most frequent is 
dropsy. This, when it occurs, is generally manifested from ten to twenty 
days after desquamation has commenced. The symptoms are eventually 
the same as in acute Bright's disease. Some authors deem it more rational 
to consider the kidney affection which follows scarlet fever as a special 
effect of the latter. It is a well known fact, however, that exposure to 
cold is an active cause in inducing the sequela. It is important to remem- 
ber that the kidneys are oftener affected after mild cases of scarlet fever 
than severe ones. It is not impossible that in many instances the urgent 
need of protection against exposure is less apparent during convalescence 
from the less severe attacks. 

For obvious reasons, only the treatment applicable in mild cases will 
herein be considered. Often hygienic measures alone will suffice. Free 
ventilation is of the greatest importance; cooling drinks should be freely 
allowed, and the nourishment should be light and easy of digestion. 
Fruits in season are generally agreeable to the patient, and, at other periods 
of the year, milk, broth, gruels, and farinaceous puddings are appropriate. 
Exposure to cold is to be avoided during the progress of the disease and in 
convalescence, but care in this respect should not lead to the error of which 
too many attendants are guilty — that of sealing up the windows, obstruct- 
ing ventilation, and burdening the patient with an excess of clothing. 
There is a custom still in vogue, which is as absurd and pernicious 
as it is ancient, — that of giving saffron-tea and gin, for the purpose, 
as it is claimed, of bringing out the eruption. This mixture is a potent 
source of evil; it almost always induces not only digestive disturbances, 
but also invites nervous irritability and brain-symptoms. To hasten the 
development of the eruption, if it is possible, and to maintain the functions 
of the skin, warm baths should be administered twice daily, at least, and 
oftener if the fever is of alarming intensitv. 

The itching which accompanies the eruption is a symptom which 
demands treatment, as it is a source of much annoyance, preventing sleep, 
and increasing the constitutional disturbance. Simple fresh lard is effica- 
cious ; a similar application, and one more agreeable, can be made of sweet- 
oil and glycerine, equal parts, and a few drops of bergamot or other per- 
fume. The throat complications will demand treatment in very many 
cases. The application of salt pork has been the popular one in times past, 
and its advocates among certain classes are many, even at the present day. 
Its efficacy is doubted, and that it adds to the patient's discomfort is 
assured. Simple water is far more agreeable, and of greater benefit. 
When the patient is of that age gargles can be used, the saturated solution 



SCARLET FEVER. 38 



of the chlorate of potassa is advised. In very young children, if the 
operation can be performed without too violent resistance, it will be well 
to cleanse the throat occasionally with a simple, painless application. For 
this purpose, powdered sulphur maybe used, water being added in suf- 
ficient quantity to make a paste. This may properly be applied with a 
camel's-hair brush, every hour or two while the patient is awake, or, if the 
child will permit its being done, the dry sulphur can be blown into the 



throat through a tube. 



In all cases, unless the bowels move very freely, it will be well t<> 
administer a cathartic early in the attack. Restlessness and sleeplessness 
if not relieved by warm baths and applications of cold to the head, demand 
the use of opiates, and paregoric in appropriate doses is advised. The 
delirium which is so frequently present in young children at night has no 
special significance, if it is absent during the day. There is but one 
medicinal remedy which it is appropriate to use in all cases of scarlet fever, 
and that is the carbonate of ammonia, of which the dose for an adult is 
three grains. This may be given every two hours, in syrup or water, until 
the fever begins to subside, and then at longer intervals. The writer 
advocates the use of this remedy, for the reason that he has observed its 
salutary effect on himself in an attack of scarlet fever, and, during his 
years of practice, has found its influence lessened the liability to kidney 
complications. In children two or three years of age, suffering from severe 
throat symptoms, he has used the muriate of ammonia with the chlorate of 
potassa, as follows: — 

^ Potass, chloratis 3 j. 

Amnion, mur 3 ij. 

Syr. aurantii cort ^ j. 

Aquse 5 ij. 

Ft. mist. Sig. : Dose, one teaspoonful. 

Of this mixture, to a child three years old one teaspoonful may be given 
every one or two hours, according to the intensity of the throat trouble. 

The length of time following an attack of scarlet fever wdiich must pass 
before the patient is exempt from danger of kidney complications is esti- 
mated to be forty days. At least during that period, he should be guarded 
against taking cold through any unusual exposure. Before leaving the dis- 
cussion of this disease, it is well to impress upon the reader the fact that 
scarlet fever and scarlatina are terms used synonymously, and have one 
common meaning. In mild cases of the malady, some physicians are wont 
to use the latter term for the purpose of discrimination, and not infre- 
quently parents tell of attacks of scarlatina from which their children 
suffered, which would have proved true scarlet fever but for the skill 
of the medical attendant. Physicians should endeavor to correct this 
error, but unfortunately many fail to do so. 



S S ERUPTIVE FEVERS. 



MEASLES. 



Measles, or rubeola, so called from the red color of the eruption, is 
essentially a disease of childhood, but may occur at any period of life. 
Like scarlet fever and small-pox, it is contagious, and a slight exposure is 
often sufficient to superinduce the affection. The contagious principle 
exists in the exhalations of infected patients, and every object which lias 
in any way come in contact with them or has been in their atmosphere 
may serve as a means of transportation. 

In the majority of cases, the attack occurs in from six to ten days 
after exposure. The first symptoms manifested are those resembling a 
common cold. There is coryza with frequent sneezing; the discharge from 
the nose is constant, watery, and irritating. The eyes are irritable, red- 
dened, and tearful ; there is more or less aversion to light, and the eyelids 
are red and swollen. The patient is languid, often complains of pain in 
the head and limbs, and chilly sensations, and he is usually exceedingly 
irritable. The appetite is impaired or lost, and, in some cases, there are 
nausea and vomiting. Bleeding at the nose not infrequently occurs. 
There is usually associated some fever, the temperature rarely risino- more 
than two or three degrees above the normal. Symptoms of bronchitis 
are generally present, the cough being dry, hoarse, and painful. There is 
a sense of uneasiness and pressure over the chest, and the breathino- is 
more or less hurried. The average duration of this, the premonitory 
stage, is from three to four days ; then the eruption makes its appearance. 

The eruption is first seen on the temples and forehead. It then 
rapidly extends over the face and neck, and is gradually diffused over the 
body and extremities; generally from two to three days pass before it 
has reached its full development. It is at first composed of little red dots 
or specks, which soon enlarge, become slightly raised, and crowd together 
in patches of irregular shape. As it assumes the papular form, it some- 
what resembles the eruption of small-pox prior to the appearance of the 
vesicles. The papules in measles are, however, larger and softer, and lack 
that shot-like feel which is so characteristic of those in variola. The 
color of the eruption in measles is dark red, offering a contrast to the 
bright scarlet redness observed in scarlet fever. In some cases, the erup- 
tion becomes diffused over the whole body ; in others, it remains in the 
form of patches or blotches, only a portion of the surface being covered. 
Between these patches the skin usually retains its natural appearance. 
The eruption is attended with itching and burning, and there is more or 
less swelling of the surface. This is especially noticeable in the face, 
which even independently of the eruption is reddened, and wears a some- 
what dull expression. 

During the stage of eruption the catarrhal symptoms persist or become 
more severe. The voice is hoarse, there is often some difficulty in swal- 






MEASLES. Bgg 

lowing; the eyes continue irritable, and occasionally there is impairment 
of the hearing power, due to the extension of the inflammation in the 
throat to the middle ear. The cough becomes moister and less frequent, 
and there is more or less abundant muco-purulent expectoration. On the 
second day of the eruption, the fever is usually at its greatest height, and 
then rapidly declines. In this stage bleeding from the nose is not uncom- 
mon. In severe cases, nervous symptoms are usually pronounced ; they 
subside as the fever diminishes. In about thirty-six hours after its appear- 
ance, the eruption begins to fade from those parts in which it was first 
seen ; it generally has disappeared by the end of the sixth day, and with 
it the febrile symptoms and constitutional disturbances. Desquamation 
follows the eruption only in a certain proportion of cases. When it occurs, 
the skin is exfoliated in very fine branny scales. During this process, in 
uncomplicated cases pursuing a favorable course, the patient is rapidly 
convalescing. More or less cough with expectoration is, however, apt to 
continue for some days, and possibly for weeks. 

Irregularities in the development and the course of measles are not 
infrequent. Among the rarer anomalous forms is the so-called "black 
measles," which is characterized by hemorrhages in various situations. At 
first the eruption presents the same appearance as the ordinary eruption 
of measles, but after the fever has continued a few days it assumes a 
dark violet color, and uncontrollable hemorrhages occur from the nose and 
mouth ; blood is also discharged from the bowels and kidneys. Recovery 
from this form rarely occurs. It may also be said that there is always 
more or less danger connected with any of the more serious forms of 
irregular development. Measles is liable to be complicated with many 
other diseases ; among the most important are capillary bronchitis, pneu- 
monia, and tuberculosis. In occasional cases, the drum of the ear is 
perforated, and the hearing power permanently impaired. Intestinal 
catarrhs, of varying severity, are quite frequent. There are also a variety 
of affections which arise in consequence of measles, and remain after the 
termination as independent diseases. Among them may be mentioned 
rachitis, chlorosis, and impoverished nutrition in general. Chronic dis- 
eases of the nasal passages, and of the eyes, not infrequently follow 
the disease in children of poor constitutions, exposed to unhealthy influ- 
ences. 

Attention to hygiene is of first importance in the treatment of measles. 
The patient should be confined to his bed, in a well ventilated room, and 
kept as comfortable as possible ; that is, neither too cold nor foolishly 
heated with heavy bed-clothing. The diet should be bland and unstimu- 
lating; milk may chiefly be depended upon. As a protection for the eves 
the room may be moderately darkened, but it must be done without 
interfering with the ventilation. It is a popular error to suppose that 
hot drinks and stimulants hasten the appearance of the eruption. The 



390 ERUPTIVE FEVERS. 

administration of the latter may be followed by very serious results. 

S Fron, formerly deemed .an indispensable remedy in all eruptive fevers, 
should not be given : it is valueless in such affections, and likely to do 
harm if used. If there is thirst, cold water may be freely taken, in small 
quantities at a time. If the fever rims very high, frequent sponging with 
tepid water tends to reduce it. The cough, restlessness, and sleeplessness, 
demand the use of an anodyne: for an adult, one teaspoonful of paregoric 
alone, or with an equal quantity of sweet spirit of nitre, may be given 
every four or tive hours as needed. Wet packs to the neck and chest 
assist in allaying the irritation in the air-passnges. If there is much 
burning and itching of the skin, the application advised in scarlet fever 
will afford relief. 

Measles is generally a mild and often a trivial disease, and many 
patients among -the poorer classes recover with careful nursing alone. 
While professional advice may not be needed in all cases, it is advisable 
that it be secured if possible. It is important that a physician be in 
attendance to watch for complications, which are so liable to occur. 



SECTION VIII. 
GEIEEAL DISEASES. 



CHAPTER I. 
DIPHTHERIA. 



DipnTHERTA is a constitutional disease, characterized by a local inflam- 
mation of the mucous membrane, especially of the nose, mouth, throat, 
and deeper air-passages, which leads to the formation in these situations of 
a false-membranous deposit. The constitutional or general disturbance has 
the character of infectious diseases, and is essentially the same as in all 
which are dependent upon or solely due to a special morbid agent or cause. 
Which causes the other is a problem still unsolved — whether diphtheria is 
at first a general disease, and the affections of the mucous membrane are 
merely secondary localizations, or whether the disease begins by local infec- 
tion, and from the part first attacked the poison enters the system and 
contaminates the whole organism. It is generally accepted that the diph- 
theritic infecting agent first fixes itself upon a certain part of the body, 
more often the mucous membrane, and there, at its point of attachment, it 
excites a local affection ; then, through absorption, the poison penetrates 
the tissues, and is soon carried throughout the whole body. 

Diphtheria develops spontaneously, originating in a miasm ; it is also 
induced by contact with objects and persons infected with the disease. It 
is, therefore, considered a miasmatic contagious disease. That the infect- 
ing element is contained in the exudation, or false-membranous deposit, is 
generally accepted. It is believed to exist also in the exhalations and in 
the excretions of the patient. Thus, contagion may be carried through the 
air, as well as transported by objects to which it lias attached itself. Cer- 
tain conditions favor the propagation of diphtheria; impure air, and exhala- 
tions from decomposing animal and vegetable matters, are important 
factors in its production. In large towns and cities., in many instances, it 
can be attributed to defective drainage, sewer-gas, and the overcrowding 
of dwellings, in or around which filth abounds. While persons of any 
age are liable to be attacked, children are more susceptible to the disease ; 
the greatest mortality is between the second, third, and fourth years. The 

391 



892 GENERAL DISEASES. 

presence of a catarrhal affection of the mucous membrane predisposes to 
diphtheritic infection; hence exposure to cold and wet, and sudden chilling 
of the body are, in a measure, influential in the development of the malady. 
The time which elapses between the reception of the diphtheritic contagion 
and the outbreak of the disease usually varies from one to eight days. 
Where the diphtheritic matter has been brought in direct contact with the 
mucous membrane, the disease has developed within twenty-four hours. 

The ushering-in symptoms of diphtheria vary much in different cases ; 
not infrequently the development is gradual and insidious, the patient com- 
plaining of ill defined ailments. The attack more often is abrupt, begin- 
ning with chilly sensations, followed by considerable or high fever, malaise, 
pains in the head, neck, and loins, loss of strength, thirst, and restlessness 
or drowsiness. Children are inclined to sleep during the day more than is 
natural for them, and to be restless at night. Accompanying the signs of 
general disturbance, or soon following their appearance, the local symptoms 
are manifested. In occasional cases, these are so slight at first there is a 
liability to overlook the existence of the throat-affection. In the majority 
of cases, however, a sensation of dryness and burning or prickling in the 
throat, with possibly a slight pain in swallowing, is complained of. There 
is more or less stiffness along the angle of the jaw, and enlargement of the 
glands of that region is observed. In some instances, the affected glands 
are very much enlarged, hard, sensitive to pressure, and the tissues sur- 
rounding them share in the swelling and inflammation. Occasionally, 
however, there is only slight glandular swelling; it may be entirely absent, 
even in severe and fatal cases. 

When the disease is fully established, an examination of the throat will 
reveal one or more white patches of false membrane, either upon a tonsil or 
in its immediate vicinity. The mucous membrane of the throat is a dark 
red, livid color, which is especially marked in the region of the diphtheritic 
deposit. The tonsils beneath are swollen, and generally the uvula is much 
enlarged. The false membrane, if small when first seen, generally extends 
until a large surface is covered. When fully developed, it is from one- 
twelfth to one-eighth of an inch thick. It is of a dark grayish color, and 
much resembles dirty white kid. While there is more or less obstruction 
in swallowing, the operation is often unattended with pain, the sensibility 
of the parts appearing in some cases to be diminished. Rarely, if ever, in 
diphtheria is there as much pain as in a simple attack of tonsillitis. In the 
disease under consideration, there is occasionally noted a partial paralysis 
of the muscles concerned in swallowing, and liquids may be thrown out 
through the nose. In many cases, the breath is notably fetid, and the odor 
is quite characteristic. 

In a certain proportion of cases, in the first few T days, or later in the 
disease, the nasal passages become involved, and are the seat of membra- 
nous deposits. In some instances, but very rarely, the affection is primarily 



DIPHTHERIA. 

developed in that situation. Diphtheria of the nose is preceded and accom- 
panied by an abnormal discharge, which at first is thin and watery. This 

soon produces irritation and swelling of the skin about the nostrils, as well 
as on the upper lip. After a short time, the discharge becomes foul-smell- 
ing, of a brownish color, and mixed with blood. 

If the larynx and air-passages below become invaded with the dis- 
ease, a croupy cough, with harsh, labored respiration, gives evidence of 
the fact. When an advance from the throat to these parts takes place, it 
is usually between the third and sixth day ; sometimes, but rarely, it occurs 
later in the course. The embarrassment in breathing may be increased 
paroxysmally, and death from suffocation be threatened. 

As the local disease progresses, the constitutional disturbance becomes 
more marked. While some patients are able to sit up throughout the 
course of the malady, others suffer from too great loss of strength. 
Nausea and vomiting often occur. In severe cases, the pulse is usually 
frequent and feeble ; sometimes it falls below the normal rate. Fever is 
rarely intense in diphtheria, and occasionally it is entirely absent. In this 
disease the constitutional and local symptoms do not always progress with 
the same severity. The former in a certain class of cases are of great 
intensity, while the local manifestations are but slight and not progres- 
sive. On the other hand, some cases run rapidly to a fatal termination, 
and yet the general disturbances are so slight the patients are up and 
about the room until within a very short time, often less than an hour, 
before death occurs. 

The duration of diphtheria is exceedingly variable ; it may prove fatal 
within forty-eight hours, and, on the other hand, it may be prolonged by 
complications for several weeks. In cases which pursue a favorable 
coUrse, the general condition of the patient grows worse each day, until 
the end of the first or the beginning of the second week, when the mem- 
brane is thrown off and the healing process commences. A simultaneous 
improvement in the local and general symptoms then takes place, and the 
patient quickly recovers. 

Blood-poisoning may occur at an early period and death follow in 
a few hours, the case assuming the so called malignant type. In the 
majority of cases, the diphtheritic processes are slower, and absorption 
from the diseased mucous membrane takes place gradually, death occur- 
ring between the tenth and fourteenth day, from three to five days after 
the first signs of poisoning of the blood are manifested. When blood- 
poisoning takes place, the face becomes bloated, pale, wax-like, and expres- 
sionless. The discharges from the mouth and nose become foul-smelling 
and corroding, the glands of the neck are enormously swollen ; the patient 
makes no complaint, but lies quietly in bed, the powers of life gradually 
succumbing to the force of the disease. If food is given, it is often 
vomited, and diarrhoea, while not invariably present, is sometimes profuse 



394 GENERAL DISEASES. 

and exhausting; blooding from the nose is a frequent symptom in fatal 
eases, and hemorrhage in other situations occasionally occurs. The tem- 
perature falls below the normal; a cold clammy sweat covers the forehead 
and extremities ; the pulse, also below the normal, scarcely reaching 
forty or fifty beats in the minute, is weak, irregular, and intermittent. 
Death occurs suddenly as a rule, consciousness generally remaining 
unclouded even in the last hours. Coma, delirium, and convulsions some- 
times appear, but they are exceptional. In the so-called malignant cases, 
the course of which is rapid, the symptoms described follow each other in 
<puck succession. It is important to remember that even when the 
general symptoms do not indicate great gravity, the patient is liable to be 
seized with a sudden and fatal attack of fainting, after some quick move- 
ment, such as sitting up or getting out of bed, or without any apparent 
cause. Such an attack may occur even in advanced convalescence, and is 
especially likely to happen when, notwithstanding apparent improvement, 
the pulse continues slow, small, weak, and irregular. 

The prognosis of diphtheria is more unfavorable the younger the sub- 
ject, for the extension of the disease into the larynx is more frequent in 
children. Of the cases in which the air-passages become involved, the 
vast majority end in death, and suffocation either causes or contributes 
largely to the fatal result. In cases in which the air-passages are unaf- 
fected, but the disease has extended into the nose, the prognosis is always 
unfavorable. Diphtheria almost always proves fatal when once the 
symptoms of blood-poisoning have appeared. Even when the disease is 
confined to the throat, if the membranous deposit is large, the chances of 
recovery are proportionately lessened. In a brief summary it may be said 
that the symptoms which are to be regarded as unfavorable are a thin, 
corroding discharge from the nostrils, huskiness of the voice, croupy cough 
and labored respiration, extreme glandular swelling, bleeding at the nose 
or hemorrhage in other situations, an extensive membranous deposit, a 
pulse that is feeble, irregular, and intermittent, or one that drops to sixty 
after having been rapid at the outset. To these signs may be added 
persistent vomiting and diarrhoea, bloating of the face, a pale, wax-like 
appearance of the same, coldness of the surface, suppression of the urine, 
convulsions, delirium, and coma. As has been properly said, all complica- 
tions in diphtheria render the prognosis unfavorable. There are a number 
of morbid conditions which frequently follow the disease; among them 
are anaemia, general debility, feebleness of the action of the heart, and 
paralysis. The latter is sometimes limited to the muscles of the throat, 
but not infrequently the muscles of some other part of the body become 
involved. 

Before discussing the measures of treatment, it should be impressed 
upon the minds of all that even mild attacks of diphtheria are always 
.serious, as danger ever lurks throughout the course. Doubtless, there are 



DIPHTHERIA. 395 

many eases in adults in which recovery takes place without the employ- 
ment of active measures. Still, the services of a physician should invari- 
ably be sought, as he only can detect those slight changes which are 
often the sole indications that what may have appeared a trilling attack 
has suddenly become a grave and possibly a fatal form of the disease. 
There is another point in this connection which it is important to empha- 
size. It is a fact beyond dispute that all physicians are not the personifi- 
cation of honesty; it is to be deplored that too many by far are given to 
chicanery, and the personnel of this class is not alone confined to charla- 
tans ; there are some even among educated physicians who will not hesi- 
tate by trickery and fraud to sacrifice professional integrity for personal 
exaltation. Not infrequently the reputed success of these people in the 
treatment of diphtheria is simply marvellous. It is common for them to 
boast of rarely losing a case. The solution is easy ; many of their patients 
have simple or follicular tonsillitis, affections which almost invariably 
recover under judicious nursing alone. The reader will do well to famil- 
iarize himself with all acute affections of the throat, and, thus fortified, 
he will meet but few cases in which a correct diagnosis cannot readily be 
reached. Small white spots on the tonsils are no evidence of the disease ; 
there must be a distinct patch of false membrane visible to the eye before 
it can be in truth said that diphtheria is present. 

When a patient is attacked with the disease, he should be at once 
confined to his bed and remain there until convalescence is fully estab- 
lished and recovery assured. The sick-room should be large and well 
ventilated, and have a temperature of 70° or 75° Fahr. The dangers of 
infection should be fully appreciated by the attendants, and every measure 
of protection taken. Of infinite importance is perfect cleanliness, not 
only in the patient but in all the surroundings. All articles used should 
immediately be thoroughly disinfected or destroyed. For handkerchiefs 
old cloths should be substituted; they can be torn into small pieces to use 
about the nose and mouth, and, after being soiled with one contact, they 
should then be burned. All bed-clothing and linen should be scrupulously 
clean, and disinfected when removed. When the coldness of the weather 
necessitates a fire in the room, a large pan of water, to which freshly 
slaked lime has been added, should be allowed to slowly evaporate with 
gentle heat. To assist in destroying the germs of the disease, ever present 
in the atmosphere about an infected patient, carbolic acid alone, or in com- 
bination with lime or some similar disinfecting agent, should be freely 
used. Attendants must mingle as little as possible with the rest of the 
household, and must avoid taking the breath of the patient. It will 
always be difficult for fond mothers to stifle their promptings, and with- 
hold the caresses which they are wont to bestow upon their children. 
They must do so, however, for to expose themselves needlessly to the 
danger of infection is an unpardonable sin, for which there can be no 
excuse. 



396 GENERAL DISEASES. 

To support the vital powers of the patient is one great object in 
treatment. The diet should be concentrated and highly nutritious, and 
the patient should be induced to take as much nourishment as can properly 
be digested; milk, strong beef-tea, and yolks of eggs, meet the require- 
ments. All authorities recognize the efficiency of alcohol as a factor in 
the supportive treatment. The amount to be used depends upon the 
indications, and upon the immediate effects. Generally to a child four 
years old a teaspoonful of brandy should be given every two or three 
hours. Tonic remedies are indicated in nearly all cases, and none are 
better than iron and quinine. To a child of the age just mentioned, ten 
drops of the tincture of the chloride of iron and one-half a grain of 
quinine should be given every four hours; if the pulse becomes rapid and 
weak, the dose should be increased. By some, to lemon-juice has been 
attributed a degree of efficacy in diphtheria ; whether rightly so has not 
been proved ; it certainly is harmless, and there are no objections to 
its use. If vomiting or diarrhoea occurs, they demand appropriate treat- 
ment. 

The importance of local treatment cannot be overestimated. With the 
best of results, during years of practice, the writer has, in all cases when it 
could be employed, used the solution of the persulphate of iron, in full 
strength, with a camel's-hair brush. This preparation is too powerful for 
other than a physician to use, and cannot be advised. It may, however, 
be diluted with glycerine, in parts one to four, and used every four hours; 
for adults, eight grains of carbolic acid may be added to one ounce of the 
mixture. In using this, the throat should be well painted, especially where 
the membrane is deposited. In very young children, this or any other 
irritating application cannot be employed, for fear of exciting symptoms 
of strangulation. In such cases the flowers of sulphur should be used. To 
them water should be added in sufficient quantity to make a paste ; it will 
then adhere to a brush, by which it can be deposited in the throat. Even 
Avhen the solution of persulphate of iron is used, applications of sulphur 
may be frequently made during the intervals. It causes no discomfort, 
tends to keep the throat free from the accumulation of mucus, and possi- 
bly it may assist in retarding poisonous absorption. Gargles of a saturated 
solution of chlorate of potassa are indicated, if the patient can use them. 
When the nose is affected with the disease, the following is advised: — 

]J Acid, carbolici 3 ss. 

Glycerinse ^ ij. 

Aquae § vj. 

Ft. mist. Sig. : Inject into the nose, every third or fourth hour. 

For the glandular swelling, a variety of applications are in use, among 
them stimulating liniments, flaxseed poultices, and hot-water compresses. 
The writer has in many cases employed as a poultice fresh, raw beef, 



DIPHTHERIA. 397 

changing the same every three hours. It is not reasonable to suppose that 

this application has any special action; still, he lias felt that it contributed 
somewhat to success. 

The measures advised constitute but a mere outline of the treatment of 
diphtheria. There are many others, among them steam-inhahiti.uis, which 
are important, but they should be under the immediate supervision of a 
physician, and only in the absence of professional assistance should the 
treatment of the writer be employed. 



CHAPTER II. 

RHEUMATISM. 

Rheumatism is, properly, a constitutional disease, characterized by 
local affections about the joints and in the muscles. The term has been so 
often wrongly applied, being used to cover an immense range of pains, 
independent of the morbid conditions which give rise to them, the truth of 
this assertion, "it ought to be expunged from our vocabulary," is indispu- 
table. Some physicians, it is to be feared, when consulted for painful 
affections, the real nature of which they are unable to determine, not infre- 
quently find it convenient to assign to rheumatism symptoms which origi- 
nate in other and possibly grave diseases. Authors divide rheumatism into 
five or more distinct varieties, and include certain affections w 7 hich properly 
should be classed among diseases of the nervous system. Among the dis- 
eases to which the name rheumatism has been applied is one the symptoms 
of which are so well defined it has by common consent been selected as a 
type of rheumatic affections, namely, acute articular rheumatism. Having 
very close relations w T ith this disease, often succeeding or following it, is 
gout, which may be said to have a common parentage, and belong to the 
same family, although it has a separable individuality. In the discussion 
to follow, only acute and chronic articular rheumatism will be considered. 

ACUTE ARTICULAR RHEUMATISM. 

Acute articular rheumatism, as the name implies, is an affection of the 
articulations, or joints. It is a constitutional malady, attended with 
fever ; hence the popular term, rheumatic fever. The local changes which 
take place in this disease are of an inflammatory character, attended 
with an exudation into the joints, and often with inflammation of internal 
organs. 

With respect to the causation of rheumatism, little is actually known. 
It has been commonly attributed to exposure to cold, damp, or other atmos- 
pheric influences. That the agencies assigned are, alone, incapable of pro- 
ducing the disease is generally accepted. A morbid peculiarity of the 



ACUTE ARTICULAR RHEUMATISM. 399 

constitution, a special predisposition, seems requisite to its development. 
When this susceptibility to the disease exists, then exposure to cold, and a 
variety of other conditions, general and special, doubtless act as exciting 
causes. Any impairment of the general health from defective nutrition 

increases the liability to a rheumatic attack. There are certain diseases 
during or after which the affection under consideration is exceptionally 
prone to occur ; prominent among those alluded to are dysentery, scarlet 
fever, and erysipelas. A variety of other affections, such as scrofula, con- 
sumption, and cancer, often precede rheumatism, and a connection between 
them is recognized. 

An attack of acute articular rheumatism is sometimes preceded by ill 
defined and trivial symptoms, such as general malaise, dragging pains in 
the limbs, etc. ; but in the majority of cases it commences suddenly, and 
more often during the night. The real onset of the affection dates from 
the appearance of the fever, — which is, in some cases, ushered in with a 
short chill, more or less marked; in others, by chilly sensations. The 
common febrile symptoms are usually associated. There may be head- 
ache; the patient complains of thirst, loss of appetite, and general discom- 
fort. The intensity of the constitutional symptoms varies in different 
cases, influenced somewhat by the extent of the local affection. The pulse 
rarely exceeds ninety beats per minute ; the elevation of the temperature 
at first is usually moderate. The fever may precede the local manifesta- 
tions for a period varying from a few hours to two days ; generally, how- 
ever, they occur simultaneously. One or more of the joints becomes 
painful, hot, swollen, and more or less distinctly reddened. The pain dif- 
fers in intensity in different cases ; it is increased by movements of the 
affected joints. In very severe cases, the patient lies motionless in bed ; 
the slightest jar causes him to cry out, and he complains even of the 
weight of the bedclothes. The large joints are usually affected first, and 
in some cases several are involved simultaneously, or in quick succession ; 
occasionally the disease is for a time limited to a single joint. As a rule, 
the swelling in the joints first affected declines in three or four days, and 
new ones are attacked with the same severity, and run a similar course. 
Corresponding joints are often involved at the same time, or, as soon as 
the inflammation in one subsides, its fellow on the other side is immedi- 
ately attacked ; thus the course pursued is remarkably symmetrical. Often, 
notwithstanding the presence of high fever, the skin does not feel very hot 
to the touch, and sweating is generally a symptom more or less prominent ; 
the sweat has a notably sour odor. A small eruption on the neck and 
trunk is not uncommon. The urine is scanty, and contains a brick-red 
sediment. The tongue is moist and coated ; the bowels are usually con- 
stipated. Sleep is greatly interfered with by the severity of the pain, and 
continued wakefulness is a source of discomfort and more or less prostra- 
tion. The patient's mind generally remains unclouded ; delirium is rarely 



400 GENERAL DISEASES. 

- rved, and when present it is of an exceedingly mild type, and confined 
to those subjects especially sensitive and irritable, in whom the fever runs 
with unusual intensity. 

Acute articular rheumatism is of itself rarely fatal. Its duration is 
extremely variable; the disease lasts from three to four days in one joint, 
but it may return in the same situation, and thus be prolonged for weeks. 
Usually, the period of fever, with attendant local inflammation, is from 
twenty to thirty days. This disease is especially liable to complications. 
It has a tendency to invade certain structures of the heart, and endo- 
carditis is a frequent occurrence. Pericarditis also occurs in a propor- 
tion of cases. Bronchitis, pleurisy, and pneumonia are occasionally devel- 
oped. There are other affections, which sometimes, but less frequently, 
appear in the course of the disease. Instead of complete recovery, acute 
rheumatism may become subacute or chronic. 

The surroundings of a patient suffering from rheumatism are a matter 
of no little importance. Free ventilation should be secured, but without 
draughts, and the temperature kept between 68° and 70° Fahr. The 
patient should be clothed in flannel, and lie between woollen blankets. His 
coverings should be light; an excess of bedclothing will add to the pain in 
the inflamed joints, and unnecessarily increase the sweating. It should be 
a studied effort to spare him any painful movements possible, and every 
ministration should be gentleness itself. Milk, with seltzer-water or lime- 
water, pre-eminently meets the requirements as the principal article of 
diet, during the active period of the disease. If this prove insufficient, or 
is not well borne, then other light and concentrated food can be adminis- 
tered. Some authorities insist that animal food and alcohol are contra- 
indicated during the height of the fever. The latter certainly should be 
prohibited, as a rule, but the patient's diet need not be so much restricted 
as in other highly febrile disorders. Those who are habituated to the use 
of stimulants should not be entirely deprived of them. 

For an external application in acute articular rheumatism, there are 
none more efficacious than mustard poultices. The use of these should be 
commenced at once, as soon as the joints become painful. If only a small 
number are affected, poultices can be applied to each simultaneously, or in 
succession until all are so treated. When new joints become involved, 
renewed applications are demanded: in fact, the disease should be "chased" 
from one affected location to another. The poultices may be applied twice 
daily, and after their use the inflamed joints should be wrapped in dry 
cotton-wool, and then bandaged neatly and lightly with flannel. Some 
authors claim that these coverings are useless, but all who have suffered 
from the disease can testify that exposure of the joints, even to the 
warm air of the sick-room, aggravates the pain. A more expensive appli- 
cation, and to some more agreeable than the mustard, is the following: — 



ACUTE ARTICULAR RHEUMATISM. 401 

]J 01. cajeputi 

Spts. camphorae ail ^ j. 

Spts. ammonite 3 vj. 

Spts. vini rect 

Chloroform i aii ^ j. 

Ft. mist. Sig. : External use only. Shake well. 

To use this, first neatly fasten over the inflamed joint flannel of sufficient 
size to cover the same; after saturating this with the mixture, quickly 
cover with another piece of flannel or oil-silk. It should create an agreeable 
feeling of heat, but if it burns too severely, the outer covering must at 
once be removed, to permit evaporation, which can be allowed for a 
moment, and then again confined. The effect of the application will indi- 
cate how often to renew it. 

During the last few years a most important discovery has been made, 
namely that acute articular rheumatism may be controlled by salicin and 
salicylic acid ; these agents, in some form, are now universally used in this 
country. The writer has long been accustomed to employ the salicylic 
acid in the form of the salicylate of soda, as the former is liable to irritate 
the throat. Many physicians use the latter agent, in twenty-grain doses, 
every two, three, or four hours, but in smaller doses it generally proves 
effective. The following combination is advised : — 

J£ Sodii salicylatis 3 iij. 

Aquse gaultherise 5 "J* 

Ft. mist. Sig. : Dose, one teaspoonful. 

This mixture should be given every two hours while the fever is present. 
In exceedingly severe cases, it may be given every hour, until the intensity 
of the attack lessens, and then a longer interval should be allowed. 

In nearly all cases, opium in some form will be demanded ; to subdue 
pain and promote sleep, one grain of this agent, or one-eighth of a grain of 
morphia, every four or eight hours, may be administered, as needed. In 
intensely high fever, quinine is indicated, and ten grains should be given, 
and repeated in two hours, unless the fall in temperature is appreciable. 
Excessive sweating is often measurably controlled by atropia, and one one- 
sixtieth of a grain granule may be given once a day. If, during an attack 
of rheumatism, there occurs a paroxysm of difficult breathing and palpita- 
tion, it will commonly yield to mustard poultices applied over the heart. 
If the inflammation is slow to abandon the affected joints, they remaining 
swollen after the fever has completely subsided, blisters or the tincture of 
iodine may be applied. In such cases, the salicylate of soda mixture should 
be discontinued, and the following given : — 

^ Tr. opii 3 vj. 

Tr. colchici rad ^ J- 

Tr. cardamon ^ * v> 

Ft. mist. Sig. : Dose, one teaspoonful, three times daily, in water. 



402 GENERAL DISEASES. 

If, aft or this preparation has been used for ten days, no improvement 
has been noted, the disease will have passed into the chronic form, and 
will demand appropriate treatment. 

Subacute rheumatism is a form which usually follows the acute, and 
may have all the character of that disease. It is in reality the same 
affection running a very mild course. It is attended with slight, if any, 
fever; the pain in the joints is not severe except on motion, and the 
swelling and redness are not extensive. The affection is usually limited 
to one or two joints. The treatment is essentially the same in this 
as in the acute form of the disease, with modifications which are sug- 
gested by the difference in intensity of the symptoms. Anaemia almost 
always co-exists, and iron in some form is demanded. Cod-liver oil is 
also useful in all cases. A warm climate is best suited to this class of 
eases. 

CHRONIC ARTICULAR RHEUMATISM. 

Chronic articular rheumatism is a disease which is almost exclusively 
confined to middle or advanced life. It occurs most frequently in those 
who have experienced repeated attacks of rheumatic fever in early life. 
It is usually subacute from the first, and whatever obstructs the complete 
restoration of the joints during the acute disease — severity of local 
inflammation, improper treatment, constitutional weakness, etc., — will, 
therefore, act as a cause of the chronic malady. Even wdien recovery is 
complete, acute rheumatism leaves a tendency to subsequent disease in the 
affected joints. They are ever after peculiarly sensitive to exposure to 
cold and damp, and similar injurious influences. 

The symptoms of chronic rheumatism proceed from the condition of 
the joints. Usually one or more of the larger joints is affected, and 
where the disease is located there is aching and constant pain more or 
less severe. The joints involved are continually tender, slightly swollen, 
and their movements are constrained ; they become from time to time the 
seat of more acute pain which comes on spontaneously, or is induced by 
obvious causes, such as pressure and movement, and certain atmospheric 
conditions. The pains are generally more acute during cold and wet 
weather. Old people, with rheumatic joints, are by their sensations often 
able to foretell the coming of a storm. The affection does not shift from 
joint to joint as in acute rheumatism, but, on the contrary, it may remain 
limited to one particular joint for months, and even years. Not infre- 
quently an attack of the acute form of the disease occurs in a patient suf- 
fering from chronic rheumatism. After the affection has persisted for a 
long time, the muscles near the joints first become painful, and then 
undergo more or less atrophy. Fever is either absent or occurs occa- 
sionally in a mild form, when the joints are unusually inflamed and 
painful. 



CHRONIC ARTICULAR RHEUMATISM. 103 

Chronic articular rheumatism runs a very tedious course, with alternate 
periods of improvement and increase in severity of the symptoms. If 
the disease follows the acute form, and is limited to one joint, a speedy 
recovery is possible, when all the conditions are favorable; but such a 
result is rare, and, as a rule, the affection persists indefinitely, dragging 
along for months, even years, and in no small proportion of eases it exists 
throughout life. In some instances recovery seemingly takes place, hut 
rarely will it be complete, by reason of certain structural changes which 
usually take place in the joints, after the disease has persisted for some 
months. In a few exceptionally severe cases the joints become stiffened 
and immovable, and the entire limb wastes, leaving the unfortunate more 
or less helpless and crippled. The disease of itself is devoid of imme- 
diate danger ; the deprivation of exercise and loss of sleep may, however, 
interfere with nutrition, and thus shorten life. 

In this form of rheumatism, local applications are principally to be 
depended upon. Counter-irritation is often useful, and should be employed 
in cases of long standing. Benefit may be obtained from flying blisters, 
or the application of the tincture of iodine. Stimulating liniments are 
serviceable in some cases, and the following should be tried : — 

J^, 01. cajeputi 

Tr. opii aa 3 iv. 

01. terebintliinse 5 J- 

Liniment, amnion ise 5 ij« 

Ft. mist. Sig. : For external use only. 

When the pain is severe, the liniment advised in acute rheumatism 
should be used. For the relief of pain, also, hot local or general baths 
enjoy a high repute. Mud-baths, and hot sand baths, are very efficacious. 
Good results often follow local sweating, which is effected by covering- 
water compresses, which have been applied to the joints, with thin sheet 
rubber; thereby the heat and moisture are retained. Massage and rub- 
bing are always beneficial, and where there is a tendency in the joints to 
stiffen, daily movements should be insisted upon. Good effects may be 
expected from the use of electricity, especially with the constant current. 
Whatever the local treatment employed, it should be given a fair trial, as 
immediate improvement cannot in any instance be expected. 

Internal remedies, which are so efficient in acute rheumatism, are of 
little or no service when the disease becomes chronic. In all cases, meas- 
ures to improve the general health should be resorted to. Such tonics as 
iron and quinine will be found useful, and cod-liver oil should be admin- 
istered continuously. Their operation should be assisted by a generous 
and nutritious diet, and, if possible, the patient should remove to a warm, 
dry climate. Among the many drugs which have been advocated for 
internal use in chronic rheumatism are, the tincture of guaiacum, col- 



404 GENERAL DISEASES. 

chicum in some form, and the iodide of potassium. The last mentioned 
may be administered after tonics have been successfully employed, and 
the health is measurably restored. It should be given in small doses at 
first, and gradually increased to ten grains, three times daily. To secure 
the full benefit of this agent, its use must be prolonged for months, if it 
is well borne on the stomach. 



SECTION IX. 
ACCIDENTAL DISTURBANCES. 



CHAPTER I. 
HEMORRHAGE. 



Only a general consideration of this subject will be attempted, and it 
will be confined to what may be termed accidental hemorrhage, in contra- 
distinction to that which results in consequence of disease of the lungs, 
stomach, liver, or other internal organs. When profuse hemorrhage from 
a wounded blood-vessel occurs, the beholder, be he friend or stranger, is in 
many instances so terror-stricken, he loses all presence of mind, and thus 
many lives have been sacrificed which might have been saved by timely 
intervention. In nearly all cases of hemorrhage, much more apprehension 
is excited than is warranted. The amount of blood actually lost is gener- 
ally much overestimated. There is a common expression, "a little blood 
makes a great show." This is quite true, for a small quantity will soil 
much clothing, and but little need, be added to a basin of water to render 
it very high-colored. It is well to remember that about one-eighth of the 
weight of the human body is blood — in other words, that, in a person of 
average size, there are from sixteen to eighteen pints. In health, a pint, 
even a quart of blood can be withdrawn from the vessels without injury, 
and doubtless in but few cases would a loss of one-third the entire amount 
contained in the body prove fatal. From this statement it must not be 
inferred that when hemorrhage occurs treatment may be leisurely applied ; 
far from it. The bleeding should in all cases be immediately arrested, 
if possible. The reader should know, however, how great a loss can 
be sustained, without life being threatened, for it is often the fear of 
immediate death that is terrorizing, and renders one powerless in such 
emergencies. 

An artery is known to have been wounded when blood of a bright red 
color spurts out in jets, corresponding to the beats of the pulse. If a vein 
is opened, dark red blood flows from the wound in a steady stream. 
Bleeding from wounded arteries is in nearly all instances by far the most 

405 



406 ACCIDENTAL DISTURBANCES. 

dangerous. In cases of hemorrhage at all profuse, firm pressure should be 
instantly made directly upon the bleeding part. The next step to be taken 
will depend upon the situation and character of the wound. If the injury 
is on either of the limbs, and is severe, it is always well to have the patient 
placed flat on his back, and the injured member elevated and supported by 
an assistant. During this procedure, the bleeding must be prevented by 
un relaxed pressure. If a small artery has been cut, it will be known 
by the size of the jet which spurted out when the wound was received. 
In such cases, bandaging directly over the wound will often control the 
hemorrhage. A pad should be made a little larger than the cut, by 
folding or rolling firmly a piece of cloth. This, when ready, should be 
placed over the wound, the fingers which have previously grasped it 
being quickly lifted up for the purpose, and as quickly should they renew 
their pressure on the pad. Over this a bandage can then be applied, a 
piece of sheet, three or four inches wide and five or six feet long, being 
used. 

If the bleeding has entirely ceased, to wet and keep this bandage sat- 
urated with cold water, and the limb supported, is all that there remains 
to do. If, however, the bleeding persists, then the treatment to be advised 
when a large artery is wounded must be employed. In such cases, no 
attempt should be made to permanently arrest the hemorrhage by bandag- 
ing the wound, but between it and the body, around the limb, a firm band- 
age, twisted handkerchief, large cord, or a piece of small rubber tubing 
should be drawn tightly and tied in a knot, to shut off the supply of 
blood. Xot until after this is effectually done, should pressure of the 
fingers on the bleeding part be relaxed. In cases where the wound is 
large, and several small arteries are opened, and pressure with the fingers 
does not control the bleeding, then the ligature should be applied above 
the injury. 

Bleeding from small veins is generally easily controlled by bandaging 
over the wound. When, however, important vessels are opened, as is 
sometimes the case with enlarged veins of the leg, then the blood should 
be cut off from the bleeding part by tightly bandaging, not between it and 
the body, but between the wound and the extremity. This simple law may 
be easily explained ; blood goes to the extremities through the arteries, but 
returns through the veins. 

To control hemorrhage in some situations is more difficult than in 
others. If a large artery is opened above the knee or elbow, it is doubtful 
if a bandage can be drawn tightly enough to cut off the blood between the 
wound and the body, without improvising a tourniquet. To do this is 
easy, however. A common handkerchief can be tied loosely around the leg 
or arm, and the slack taken up by twisting with a cane or stick, until suf- 
ficient pressure is exerted to prevent the passage of blood to the wound. 
The advice of Dr. Hope is well worth remembering : " If you be by your- 



wounds. 107 

self in the fields, and get a severe cut with a scythe, or in any sudden emer- 
gency, such as a railway accident, use the remedy which has saved many a 
life on the field of battle. Take a handful of dry earth, put this on to tin- 
wound, and grasp tightly, till you call some assistance." As previously 
stated, in nearly all cases of hemorrhage from wounds, there is no necessil v 
for the alarm often shown, especially as fear perverts the judgment of those 
who could much more serve the true interests of the sufferer by keepin« 
cool and collected. Of course, in all emergencies, a physician should be 
immediately sent for. If the bleeding is controlled by pressure of the 
fingers, all other operations which follow can be done leisurely, as there is 
no urgent haste, and none should be indulged in. 

Bleeding from the nose, unless it be profuse or prolonged, requires 
little interference. Prof. Henry J. Bigelow's treatment for nosebleed is: 
Keep the head erect, place a basin under the chin for the blood to run into, 
and then the patient should take several deep inspirations, filling the chest 
fully at each breath. In most cases, by this treatment the bleeding will 
soon cease. Bathing the neck and face with cold water, or applying ice to 
the nose, is often advantageous. Plugging the nostrils with cotton might 
be tried, but rarely will it prove effectual, for the blood usually flows back 
into the throat. In urgent cases a physician should be sent for. 



WOUNDS. 

There are four varieties of wounds which it is of practical importance 
to consider: the incised wounds, those made with clean-cutting instru- 
ments ; the punctured, those made by instruments of greater length than 
breadth (in these are included stabs and pricks of all kinds) ; the lacerated, 
in which the parts are torn ; and the contused, those effected by bruising. 
The incised wounds are usually produced with the least violence, and are 
generally the most easily repaired. The punctured are dangerous from the 
depth, and from the possibility of hemorrhage and injury to the internal 
organs ; abscesses are liable to follow deep wounds. In lacerated wounds 
the edges are ragged, and in the contused there is more or less loss of 
tissue. These two varieties are commonly produced by greater violence ; 
they heal more slowly and are prone to suppurate. They generally bleed 
less than the incised or punctured w T ounds, because arteries when torn 
contract, and close more quickly than when cut. 

In the treatment of incised wounds, after the hemorrhage has ceased, 
and the clots, with dirt or any other foreign matter, have been gently 
removed by sponging, or by a stream of water directed into the cut, the 
edges of the wound should be brought carefully together. To retain them 
in position until union has taken place, stitches, or strips of adhesive plaster, 
may be used. If the cut is a long one, or in such a situation that the 
wound exhibits a tendency to gape open, then the former will be necessary, 



ACCIDENTAL DISTURBANCES. 

as the latter soon moistens and stretches, or becomes detached. If adhe- 
plaster is used, it should be what is commonly known as surgeon's 
plaster. This should be cut lengthwise with a pair of & iss re, into uni- 
form-sized strips, of about a quarter of an inch or less in width. They 
will need to be long- enough to extend well over the wound on each side, 
and secure a firm hold on the skin. The plaster must be heated just 
before it is used. Where several strips are needed, it is well to begin at 
one end of the wound, and work over to the other, crossing the incision at 
right angles. After attaching the strip to one side, the skin of the other 
side should be pressed up with the fingers, until the edges of the wound 
are brought together: then the rest of the strip can be rapidly attached. 
The strips of plaster should never be brought close together, but a 
small space ought to be left between each, to permit the escape of fluids 
which form in the wound. To apply plaster to the scalp, it will be 
necessary to shave the hairs, or it will not remain attached. A popular 
and pernicious custom is to cover the wound with a large piece of plaster, 
thereby retaining the secretions, and inviting inflammation and suppura- 
tion. After a wound has been properly closed and strapped as advised, 
it should be covered by several folds of antiseptic gauze, which can be 
obtained at all druggists': this may be secured with a bandage. To the 
covering in the region of the injury cold water should be frequently 
applied. If the gauze cannot be obtained, a compress of linen may be 
substituted, and kept moist with a solution of carbolic acid, made by add- 
ing one and one-half drachms of the crystals to a pint cf water. As a 
general rule, the dressings ought not to be removed until the third or 
fourth day. and then they should be quickly changed, and prolonged 
exposure to the air avoided. As I'-vi^ as the plasters retain their hold 
upon the skin, and keep the edges of the wound together, they should not 
be disturbed. After a time, however, it may become necessarv to replace 
them with fresh strips. Great care should be used in their removal, but 
one being detached at a time, and a fresh strip substituted before another 
is loosened. To avoid tearing the wound apart, it will be necessarv to 
commence at the extreme end of the strip, and separate it gently and 
slowly, until the line of the incision is reached : then :' 3 : ther end may be 
similarly treated. Xot infrequently the strip- of plaster become moistened 
with the fluids from the wound, and by stretching they allow it to re-open. 
In such cases it should be closed in the same manner as when first dressed. 
When antiseptic gauze is used, it need not be change.] oftener than three 
or four days. If the injured part- become much inflamed, swollen, and 
painful, poultices must be substituted. 

In the treatment of extensive and deep punctured wounds, as in stabs, 
it is to be remembered that the cut in the skin is liable to unite, and thus, 
by confining the discharge, give rise to deep-seated abscesses. Unless the 
external wound is very large, and the edges are widely separated, no 



BUENS AND SCALDS. W)9 

attempt should be made to close them. A dressing of antiseptic gauze 

should be lightly applied. In small punctured wounds it is wiser to band- 
age them with some degree of firmness. In all cases the pails should In- 
kept at rest as much as possible. If, after a few days, considerable pain is 
felt, and there are signs of inflammation around the injury, the dressing 
should be removed, and a poultice applied to encourage a discharge of 
the retained fluids. Not infrequently it will be necessary for a surgeon to 
enlarge the external opening. 

In lacerated wounds, the torn and ragged edges should be brought 
together with strips of adhesive plaster or stitches, and the subsequent 
treatment is essentially the same as in incised wounds. Those from bites 
should be first freely cauterized. In contused wounds there is usually 
more or less tissue removed, and the edges are rough and irregular. If 
superficial and deserving of treatment, they generally do well under cold 
applications. When the deeper tissues are severely injured, and the 
vitality of portions is destroyed, there must necessarily be inflammation 
of the bruised parts, with consequent discharges. At first, after insuring 
perfect cleanliness, the edges of the wound should be brought together 
as well as possible, with strips of adhesive plaster, and then a dressing of 
antiseptic gauze used. After four or five days, when sloughing has com- 
menced, if the wound is large, poultices should be applied to hasten the 
separation of those parts, the vitality of which has been destroyed. They 
should be persisted in until the tissues damaged beyond repair become 
detached; the wound then appears as a cavity of greater or less depth. 
While this discharges freely, the poultices should be persisted in ; after 
their use is no longer indicated, the oxide of zinc ointment may be 
employed as a dressing. Old indolent suppurating wounds which heal 
slowly, need stimulating occasionally ; for which purpose caustic can be 
used, not extensively, but simply touched here and there over the entire 
surface. 

BURNS AND SCALDS. 

Extensive burns are always serious even if but superficial. The severe 
pain is exhausting ; the internal organs are liable to become affected, and 
the healing stage is long and debilitating. It is important that some 
relieving application be made as soon as possible to a burned or scalded 
part, and, for a time at least, domestic remedies must be relied upon. 
Among them a solution of common baking-soda is most effectual in reliev- 
ing the acute pain ; when the burn is only superficial or not severe, it 
will remove it entirely in a very short time. It has the advantage of 
cleanliness, is always at hand, and if applied at once, it will, in a great 
measure, prevent blistering, and the destructive changes in the skin. 
All that is necessary is to cover the injured parts with a thin cotton oi- 
lmen cloth, and keep it constantly wet with the soda lotion to prevent 



410 ACCIDENTAL DISTURBANCES. 

its drying. The relief felt from this application is immediate, and, in 
many cases, the acute pain subsides in less than half an hour. This solu- 
tion may be persisted in for two or three days, and then the oxide of zinc 
ointment can be substituted. 

If the injury is a severe one, and large blisters have formed, it will be 
well to use the soda until " carron oil" can be prepared. This is a mixture 
of equal parts of linseed oil and lime-water; it is a very offensive prepara- 
tion, but highly effective if the oil used is pure. When obtained, the 
blisters should be carefully evacuated with a needle, gently flattened down 
by pressure, and then covered with a linen cloth soaked in the oil. Over 
this should be wrapped flannel or soft cotton-wool, to exclude the air from 
the injured parts, protect them from cold, and smother the disagreeable 
odor. The dressing should not be changed for several days. After the 
pain has subsided, and suppuration is established, poultices of bread and 
water may be applied to hasten the detachment of those shreds or larger 
masses of tissue which have been destroyed by the burn. When the pro- 
cess of separation is completed, the wound is clean, and repair has com- 
menced, then the oxide of zinc ointment may be employed until a cure 
is established. Opiates may be required to quiet the pain. After exten- 
sive burns, there is more or less exhaustion of strength, and patients must 
always be sustained by a nutritious diet ; in some cases, stimulants will be 
indicated, 

If the clothing of a person takes fire, he should at once be thrown 
down, as the flames tend to rise towards the mouth and nostrils. Then, 
on the instant, the unfortunate should be rolled in the carpet, hearth-rug, 
or the first thing suitable which is at hand, so as to stifle the flames, the 
head only being left uncovered. To keep the flame as much as possible 
from the face, and thereby prevent the entrance of the hot air into the 
lungs, is of the utmost importance ; therefore, whatever covering is used 
should first envelop the neck and shoulders. The severe pain which 
attends very deep burns can usually be best controlled by the prolonged 
application of cold water. The writer recalls a very severe case in which 
this treatment was employed with the greatest success. The patient was a 
moulder who by accident had one of his boots, which reached to the knee, 
nearly filled with molten iron. As might be expected, the burn was a 
terrible one, and the pain agonizing. For forty-eight hours this man's leg 
was kept in a tub of very cold water ; at the end of that time the pain 
subsided, and the usual dressings were applied. After some weeks entire 
recovery took place. 

Troublesome burns from lime, caustic potash, and other strong alkalies, 
are not infrequent. Dilute acids, such as vinegar and water, or lemon- 
juice, are the remedies to be employed. Concentrated acids will, like the 
stronger alkalies, destroy the living tissues. In such cases, water, if freely 



BURNS AND SCALDS. 1 1 1 

used, will dilute them and arrest their action. Alkalies also neutralize 
acids, and convert them into harmless preparations. Common earth, 
gathered almost anywhere and applied in Landfills, contains alkali enougL 
of one kind or another to entitle it to the consideration of being one of 
the best, and at the same time most easily secured, applications in cases 
of burns by acids. 



CHAPTER II. 

FRACTURES AND DISLOCATIONS. 

Oxly a brief consideration of this subject will be attempted, as in all 
cases of fracture or dislocation the services of a surgeon are absolutely 
necessary. It is important, however, that non-professionals be able to 
recognize injuries of this character when they occur. They should also be 
familiar with the simple measures to be employed, in the interval which 
must elapse before the arrival of competent professional assistance. 

Fracture is said to be simple, when there is no wound of the skin com- 
municating with the broken part; compound, when there is such a wound; 
comminuted, when the bone is broken in several fragments. In young 
children fracture is sometimes partial, part only of the fibres breaking and 
the rest bending; to such the name green-stick or willow fracture is given. 
The long bones are most commonly broken, but any other may give way 
to direct violence. 

The symptoms of fracture are deformity ; such as displacement, bend- 
ing, shortening, or twisting. Unnatural mobility; as shown by grasping 
the two ends of a broken bone and moving each independently of the 
other, or the yielding of a part on pressure. Crepitus ; a grating sound 
heard or felt when the broken ends are rubbed against each other. Of 
these three signs deformity is often absent in fractures of the ribs, pelvis, 
and shoulder-blade ; crepitus is prevented when the broken ends are dis- 
placed, and can only be felt when they are drawn into their natural 
positions. In addition to these symptoms there is more or less pain, 
swelling, and helplessness of the injured part. Dislocations are character- 
ized by deformity and displacement. The external appearance of the 
joint is changed, the prominence disappears or moves to another part, 
usually leaving a depression in its place. A dislocated limb may be longer 
or shorter than the normal, according as the head of the bone is displaced 
upward or downward. It loses its mobility; can no longer be moved 
about freely and in as many directions. Movements cause pain, and some 
swelling occurs. 

To distinguish between fracture and dislocation is rarely difficult ; in 
the latter, crepitus is absent, the bone can be moved less freely than 

412 



FKACTTJKES AND DISLOCATIONS. 413 

natural, while in fracture mobility is increased. If a broken bone is 
drawn into its proper shape and position, the deformity then disappears, 
but returns as soon as extension is discontinued ; when a dislocated bone 
is drawn into place, it will usually remain there. 

In instances of suspected fracture or dislocation, the limb should be at 
once placed in as comfortable a position as possible, remembering that 
broken limbs should always be handled with exceeding care and tender- 
ness, that the fragments may not be more displaced, and the tissues 
mutilated by the splintered ends of the bones. If a leg is injured, and 
it is necessary to remove the patient from the spot where the accident 
happened to his home or. the hospital, a stretcher should be secured or a 
substitute found. A wide board, a door, or a shutter, will answer even- 
purpose. After the patient has been gently placed on the litter, the 
fractured limb should be arranged against the other, and bound to it with 
handkerchiefs. Thus the sound limb can be made useful as a temporary 
splint. If taken to his home, the unfortunate should then be put on a hard 
bed, and the clothing removed by opening the seams ; the limb may then 
be supported by a soft pillow. Until competent assistance arrives, cloths 
wet in cold water should be kept over the seat of the break. When 
fracture of the arm occurs, it should be at once placed in a supporting 
sling. 

If surgical assistance can be secured within a reasonable time, to make 
the patient as comfortable as possible during the interval of waiting is the 
only treatment demanded. It is a popular idea that a broken bone must 
be "set" immediately, and as a consequence not infrequently the case is 
intrusted to incompetent persons. A delay of a few hours can rarely be 
productive of serious results ; the pain will, however, generally continue 
unabated while the bones are displaced. It is not impossible that the 
reader may find himself so situated the assistance of a surgeon cannot be 
secured, and some unfortunate will be obliged to depend upon his friendly 
efforts in the emergency. A brief consideration of the treatment of a few 
of the more common fractures is therefore advisable. 

Fracture of the collar-bone is easily detected ; on the sound side the 
bone is smooth and even, while on the injured side a lump will be found, 
caused by the broken ends rising one above the other. If the shoulder is 
brought forward, the parts will be seen to move, and the patient's pain will 
be intensified. He should be placed on his back; the fragments will then 
fall into place. Tear up a piece of flannel or soft cloth in strips about six 
inches wide, and roll up sufficient to make a pad the size of your wrist ; 
place this in the armpit, and secure it there with a piece of tape carried up 
on to the shoulder, there crossed and tied around the neck. Bring the 
elbow to the side, and place the hand on the opposite shoulder: then, with 
wide strips of sheeting, bandage the arm securely to the side, and render 
it immovable. The bandage should not extend higher than the pad in the 



414 ACCIDENTAL DISTURBANCES. 

armpit. To secure the hand on the affected side to the shoulder on the 
other, tie a handkerchief loosely around the wrist, knot it, and then 
extend the ends around the neck, making a very short sling. 

In fractures of the limbs splints will be needed, and these can be easily 
fashioned out of thin pieces of board, of the length of the broken bones; 
ordinarily they should be about three inches wide. Pad these with soft 
cloth or cotton-batting, and, having drawn the injured limb steadily and 
slowly out to the length of its mate, the splints can then be adapted, and 
firmly bound around the part. If the arm is broken above the elbow, four 
splints will be needed; they should be about two inches wide, and long 
enough to reach from the shoulder to the elbow. Place one on the front, 
one behind, and the others on the sides, and secure them with a bandage. 
Carry the arm in a sling, but do not support the elbow. If the forearm is 
broken, use two splints ; place one along the palm of the hand to the bend 
of the elbow, the other along the back of the hand to a little beyond the 
elbow, keeping, in the meantime, the thumb uppermost, and steadily pull- 
ing on the hand to draw the bones into place. The bandage should not 
be too tightly applied at first, as the parts will swell considerably. After 
the swelling begins to subside and the bandage loosens, apply another as 
tightly as necessary over it. Support the arm in a sling. If the foreleg 
is broken, rest it on a pillow, turn up the sides, and bind it tightly around 
the limb. Place outside of the pillow two splints, extending its length, and 
again bandage. Keep the foot pointing directly upwards. If the thigh is 
broken, take two strips of sheeting about three feet long and four inches 
wide, lay them along each side of the lower leg, and bandage over them 
from the knee to the foot. Cross the strips over the instep, bring the ends 
together under the foot, and tie. Into the loop thus made fasten a cord, 
extend it over the foot of the bed, and on the end sling a seven or eight 
pound flatiron ; allow this to hang, and by its weight draw steadily on 
the leg. Around the broken thigh, place four splints, and secure them 
with strips of bandage knotted in front. Fragments of a broken arm 
will unite in about a month, and six weeks are required to repair a broken 
leg. 

Among the most important dislocations is the displacement of the arm 
at the shoulder-joint. It generally results from a blow or a fall. When 
this accident occurs, the arm cannot be raised, nor the elbow T be brought to 
the side. There is severe pain when movement is attempted ; the shoulder 
is flattened; there is a depression on the outer part, just below the angle, 
and the head of the bone can sometimes be felt in the armpit. This 
deformity can readily be seen when the two shoulders are compared. To 
rednce the dislocation, place the person flat on his back on the floor. Sit 
down by his side, facing him. Pull the boot off your foot corresponding to 
his injured side. Place your heel in the armpit; then, grasping the elbow- 
joint firmly, pull the arm steadily and continuously, without jerking, in a 



SPRAINS. — ARTIFICIAL RESPIRATION. 4 1 5 

direction nearly at right angles with the patient's body. After Bteadily 
drawing for half a minute, press upward with the heel, and, still pulling, 
carry the arm in to the patient's side By this movemenl the head of the 
bone will be lifted, and will slip into place with a perceptible jerk. A pad 
should then be placed in the armpit, the arm bound to the side for a week, 
the hand, in the meantime, being carried in a sling. 



SPRAINS. 

Sprains are of frequent occurrence, and often demand careful treat- 
ment. When severe, they are attended with acute pain, heat, and swell- 
ing, with subsequent weakness and stiffness. When a large joint is 
affected, there is often considerable constitutional disturbance, fever, rapid 
pulse, etc. It has often been said that a bad sprain is worse than a fracture. 
It is certainly a very serious trouble, especially if the ligaments which bind 
the bones together are lacerated. 

Perfect rest to the affected limb is the most essential measure, and a 
splint should be used in its support. To lessen the supply of blood to the 
injured member during the inflammatory stage, it should be elevated, and 
cold applied. Cold- applications may be made to the joint either by cloths 
wrung out of cold water, or by powdered ice, tied up in towels or in a 
rubber bag. A very convenient method of keeping the cloths wet without 
changing them is as follows : Fill a pitcher or some other vessel with water, 
and place it higher than the limb. Moisten a string or a strip of linen, and 
place one end of it in the water ; let the other hang on the outside, and 
rest it on the cloths which cover the injured part. The water will be con- 
tinuously conducted along the string or linen used. The application of 
cold should be persisted in until the inflammation has subsided ; the swell- 
ing may then be reduced by bandaging, uniform firmness and pressure 
being used. More or less stiffness of the joint will remain for a time; this 
may be overcome by gentle movements, if they do not excite more than 
momentary pain. If, however, the pain is more or less persistent, then the 
part must be kept still longer at rest. The local treatment to restore the 
action of the joint is much the same as in chronic rheumatism. Stimulat- 
ing liniments may be tised ; it matters but little which is selected ; the 
efficacy of all depends almost entirely upon the hard rubbing employed in 
their application. One part to three of liniments ammonia and camphora 
make a good preparation. 

ARTIFICIAL RESPIRATION. 

In cases of suspended animation, as by suffocation or drowning, the 
ready method of Marshall Hall is advised. His directions are as fol- 
lows : — 



416 ACCIDENTAL DISTURBANCES. 

1st. Trent the patient instantly, on the spot, in the open air, freely 

exposing' the face, neck, and chest to the breeze, except in severe weather. 

2d. In order to clear the throat, place the patient gently on the face, 
with one wrist under the forehead, that all fluid, and the tongue itself, may 
fall forward, and leave the entrance into the windpipe free. 

3d. To excite respiration, turn the patient slightly on his side, and 
apply some irritating or stimulating agent to the nostrils, as veratrine, 
dilute ammonia, etc. 

4th. Make the face warm by brisk friction; then dash cold water 
upon it. 

5th. If not successful, lose no time ; but, to imitate respiration, place 
the patient on his face, and turn the body gently, but completely, on the 
side, and a little beyond; then again on the face, and so on, alternately. 
Repeat these movements, deliberately and perseveringly, fifteen times only 
in a minute. (When the patient lies on the thorax, this cavity is com- 
p>ressed by the weight of the body, and expiration takes place. When he 
is turned on the side, this pressure is removed, and Aspiration occurs. 

6th. When the prone position is resumed, make a uniform and efficient 
pressure along the spine, removing the j)ressure immediately before rota- 
tion on the side. (The pressure augments the expiration ; the rotation 
commences mspiration.) Continue these measures. 

7th. Rub the limbs upward, with firm pressure and with energy (the 
object being to aid the return of venous blood to the heart). 

8th. Substitute for the patient's wet clothing, if possible, such other 
covering as can be instantly procured, each bystander supplying a coat or 
cloak, etc. Meantime, and from time to time, to excite inspiration, let the 
surface of the body be slapped briskly with the hand. 

9th. Rub the body briskly, till it is dry and warm ; then dash cold 
water upon it, and repeat the rubbing. 

Avoid the immediate removal of the patient, as it involves a dangerous 
loss of time; also, the use of bellows, or any forcing instrument ; also, the 
inarm bath, and all rough treatment. 



CHAPTER III. 
POISONS. 

A poison lias been defined as any substance which, when applied to the 
body externally, or in any way introduced into the system, without acting 
mechanically, but by its own inherent qualities, is capable of destroying 
life. Poisons may be introduced into the body in various ways and in 
various forms. Thus, they may be administered by the mouth, or by the 
intestinal opening, and they may be given in the form of solids, liquids, 
or gases, uncombined or mixed with various matters. Nearly all medi- 
cines are poisonous in improper doses, and even common salt has been 
known to produce death when taken in large quantities. Accidental poi- 
soning is not a rare occurrence, and it is therefore essential in this work 
to consider the common poisons, with the prominent symptoms, and direc- 
tions for treatment. The convenience of the reader has been studied in 
the following classification, and ready reference made easy, as, when the 
emergencies arise, success in cases of poisoning will be largely dependent 
upon the immediate administration of the remedy. 

Acid, acetic. Instances of poisoning by this agent are rare. In 'one 
of the recorded cases, a man by swallowing two or three ounces of the 
undiluted acid was brought into a condition of great danger, from which 
he was with difficulty rescued. The prominent symptoms were at first 
slight collapse, and suffocation from closure of the opening into the wind- 
pipe, from which he recovered by tracheotomy, and after re-action great 
thirst, salivation, pain in the throat, and inability to swallow. No evi- 
dences were noted of serious gastric, pulmonary, or cardiac disturbance. 

Treatment. Draughts containing magnesia, or its carbonate, chalk, 
lime-water, whiting, or plaster scraped from the walls, followed by muci- 
laginous drinks, such as flaxseed-tea, gum-arabic water, etc. 

Acid, carbolic. Taken internally, in large doses, and in a concen- 
trated state, this agent operates as an irritant or corrosive poison. A case 
is recorded of instant death, in a man who, half intoxicated, had swallowed 
a bottle of it in mistake for rum. Where a fatal result is delayed, the 
symptoms are at first a burning sensation in the mouth, gastric pain, vom- 
iting of frothy mucus, great nervous excitement, soon followed by signs 

417 



418 ACCIDENTAL DISTURBANCES. 

of intoxication, then loss of power and insensibility, cold, clammy skin, 
difficult, rapid, and superficial breathing, pupils of the eyes contracted, 
odor perceptible in breath. If death ensues, it is generally preceded by 
violent convulsions. Mild forms of carbolic-acid poisoning are often 
observed after its excessive use as an external application to wounds, 
ulcers, etc. In such cases the most notable symptom is a cloudy, smoky 
appearance of the urine. 

Treatment. Xo antidote is known. The treatment consists in the 
immediate administration, in large quantities, of sweet oil, milk, magnesia 
in lime-water, soap in water, or any other simple alkaline mixture, followed 
by brain-stimulants, such as the aromatic spirit of ammonia, in teaspoonful 
doses, well diluted, and repeated every fifteen minutes until returning con- 
sciousness is noted. 

Acid, hydrocyanic {prussic acid). This is a rapid and most deadly 
poison. In a large dose death is almost instantaneous, so speedy that 
there is seldom any chance to employ remedies. In smaller doses the 
symptoms are pain in the head, faintness, dizziness, stupor, loss of sight, 
insensibility, rattling respiration, dilated pupils, involuntary evacuations, 
and convulsions which terminate in death. The cyanide of potass 'aim, 
one of the salts of hydrocyanic acid, is much in use by photographers, 
electrotypers, etc., and has been taken as a poison. It acts almost as 
rapidly as prussic acid itself. 

The kernels of the peach, apricot, nectarine, cherry, and certain other 
vegetable substances, among them the leaves of the cherry laurel, and the 
pips of apples and pears, yield prussic acid. Alarming symptoms have 
followed the eating of bitter almonds too freely. Death has been caused 
by the inhalation of prussic acid fumes. 

Treatment. Dash cold water at once freely on the head and spine, 
and repeat the operation often and continuously. Let the sufferer inhale 
ammonia, and put about one-half of a teaspoonful into a tumbler of water, 
or, what is still better, into one rilled with brandy and water, in equal 
parts, and spoon it into him if he can swallow. Apply a mustard paste 
to the stomach, and prolong life by artificial respiration. There is no 
chemical antidote to this poison which can be relied upon. A solution of 
the sulphate, and the tincture of the chloride, of iron, ten grains of the 
former, and one drachm of the latter, in one ounce of water, is the nearest 
approach to a specific remedy. Even were these agents at hand, it is 
doubtful if the employment of the mixture could be timely enough to be 
advantageous. 

Acids, mineral. The mineral acids commonly encountered are sul- 
phuric acid {oil of vitriol), nitric acid (aqua fortis, red spirit of nitre). 
and hydrochloric acid (muriatic acid, spirit of salt). To these maybe 
properly added the so-called mixed acids, the nitro-muriatic and nitro-sul- 
plmric, both of which are used for commercial purposes, and might be 
employed as poisons. 



poisons. 419 

Symptoms. The symptoms produced by the mineral acids are much 
the same in all cases. There is violent burning pain in the mouth, passage 
to the stomach, and in the stomach itself, which follows immediately the 
swallowing of the poison. The burning is followed by retching, and vomit- 
ing of a dark-colored liquid, with shreds of mucus and portions of the 
mucous membrane which covers the internal surface over which the agent 
has passed. The inside of the mouth is shrivelled, the tongue red and 
glazed, the lips black, the eyes red and sparkling. There is great thirst, 
difficulty in swallowing, a croupy cough, and impeded respiration. The 
pulse is full, and tense, the skin dry and hot. Next succeeds exhaus- 
tion, the pulse becomes rapid and feeble, the skin grows cold and clammy, 
the countenance is pinched, anxious, and expressive of great suffering. 
Death then speedily occurs, the intellectual faculties remaining clear to the 
last. 

The symptoms described are those usually manifested where these acids 
have reached- the stomach. . They may prove fatal, however, without enter- 
ing that organ, by causing suffocation, the opening into the windpipe 
becoming closed by the swelling of the throat and adjacent parts. Cases 
are on record where the acids have been injected into the body by other 
openings, and even poured into the ear during sleep. 

Where recovery takes place from their immediate effects, death fre- 
quently results at the end of one or two years, from stricture of the pas- 
sage wdiich leads from the mouth to the stomach. Here, as in the case of 
all burns, of whatever character, the loss of tissue is only partially supplied, 
and the affected surface is covered at the expense of the surrounding mem- 
brane, thus causing a contraction. The fumes of the mineral acids have 
been known to cause death in a number of instances, by inducing inflam- 
mation of the lungs and air-passages. 

Treatment. Give instantly either magnesia, chalk, whiting, lime-water, 
soda, saleratus mixed in water, or, what is better, in milk and water. If 
none of these substances is within easy reach, knock a piece of plaster off 
the wall, pound it quickly, and give that in milk or water. Whatever 
solution is used, a wine-glassful should be given every two or three minutes. 
At the same time an assistant should cut up common soap into small bits, 
and give a teaspoonful with water, or, if there is soft-soap in the house, a 
tablespoonful of that should be swallowed. Warm water and mucilagi- 
nous drinks, such as linseed-tea, barley-water, milk, gruels, etc., may also 
be given freely, and should be continued for some time after a sufficiency 
of the antidote has been taken. 

Acid, oxalic (acid of sugar). This is one of the most important 
poisons; not only is it frequently made use of in suicide, but many fatal 
mistakes have occurred in consequence of its being sold for Epsom salts, 
which in appearance it closely resembles. Nothing however can be easier 
than to distinguish them by tasting a minute portion of the suspected 



4:20 ACCIDENTAL DISTURBANCES. 

substance, which, if oxalic acid, will be found strongly sour, whereas 
the salt in question is bitter. Unfortunately in the instances of these 
fatal mistakes, no suspicions being awakened, the solution is swallowed 
with haste, and the mischief is done before the victim is aware of his 
danger. 

When the dose is large, half an ounce or more, and the solution con- 
centrated, it proves rapidly fatal. It produces a hot, burning sensation 
in the throat and passage to the stomach in the act of swallowing, a 
severe burning pain in the stomach, and in most instances immediate 
vomiting. The ejected matters are strongly acid, and of a dirty green 
or black color. The remaining symptoms are a sense of suffocation, 
jerking respiration, lividity of the countenance, great prostration, cold, 
clammy perspiration, and convulsions which speedily terminate in death. 
When a smaller quantity is taken, much diluted, the caustic properties are 
weakened, but the effect upon the nervous system is manifested by cramps 
and numbness. 

Treatment. Remedies must be promptly given, or they will be useless. 
Chalk, magnesia, lime-water, whiting or pounded plaster in water, must be 
administered immediately. Afterwards mucilaginous drinks should be 
freely used, and stimulants if there are symptoms of collapse. 

Acid, tartaric. Cases of poisoning with this agent are exceedingly 
rare ; still, the fact that death has been caused by it when taken in large 
quantities, in mistake for aperient salts, warrants its mention among the 
possible poisons. 

The treatment to be pursued is much the same as advised in oxalic- 
acid poisoning. 

Aconite. In large doses this agent causes much nervous excitement, a 
numbness and tingling in the mouth and throat, confusion of the intellect, 
giddiness, great muscular weakness, nausea, vomiting and purging, pain in 
the abdomen, and sometimes delirium and slight stupor. The pupils are 
unusually dilated, the skin cold and covered with a profuse sweat, the 
pulse exceedingly feeble, and the breathing irregular and oppressed. Fre- 
quently the sufferer is perfectly conscious, though paralyzed, till death 
suddenly occurs, after two or three hurried gasps. 

Treatment. An emetic should be given immediately ; then stimulants 
of brandy or ammonia both by the mouth and injection. Warmth should 
be applied, and friction persisted in. As soon as the emetic acts, a large 
dose of castor-oil should be administered, and animal charcoal, if any is 
within reach, should be generously given. Benefit may be derived from 
the use of strong coffee. Artificial respiration should be employed if the 
breathing falters. 

Alcohol. Cases of poisoning by alcohol which prove fatal most com- 
monly occur among children, on whom it acts as a powerful narcotic. The 
symptoms are brief but wild excitement, then stupor, delirium, and pro- 



poisons. 421 

found insensibility, which not infrequently terminates in death. Some of 
the less pronounced symptoms of poisoning by alcohol are occasionally 
observed in cases where very large doses of simple drugs have been taken 
in the form of tinctures. For instance, the sweet tincture of rhubarb, 
which is largely made up of alcohol, is popularly considered a harmless 
lemedy, and not infrequently it is taken in very large doses. If two 
ounces is the quantity used, the amount of alcohol contained would, as 
prepared by some druggists, nearly equal a gill of brandy. Patients 
unaware of this fact are invariably frightened by the symptoms which 
follow, rarely appreciating that they are intoxicated, but readily, and 
quite naturally, assuming that they have been j^oisoned. 

Treatment. If a child is the sufferer, it should be held in the arms 
and the head placed under a faucet or pump, and a douching of cold 
water be persisted in until consciousness is restored. Then an emetic of 
mustard or ipecac should be given, and followed by the aromatic spirit of 
ammonia in doses adjusted to the age of the child. If a physieian is not 
called, the druggist from whom the ammonia is obtained will advise what 
quantity to give. 

Ammonia (hartshorn, smelling-salts, ivater of ammonia). Two cases 
of poisoning by water of ammonia have occurred in the practice of the 
writer. The first was during bis hospital service. The unfortunate 
was suffering from typhoid fever, in the height of the disease and perfectly 
unconscious. His condition was so precarious, a visit was made to him in 
the middle of the night, and it was deemed necessary to give a table- 
spoonful of a solution of quinine. This the nurse was directed to admin- 
ister in a drinking-cup. The first swallow of the supposed mixture of this 
medicine produced such suffocative symptoms, the writer, who stood near, 
sprang to the bedside and caught the cup from the attendant's hand. To 
his horror, he found undiluted water of ammonia was being given by the 
sleepy nurse, who had terribly blundered in the medicine closet. Death 
followed in a few hours. 

The second case was that of a toper, who, on retiring, placed his cher- 
ished bottle of gin on the mantel in his sleeping apartment. Awaking in 
the early morning, while the light was yet insufficient for him to clearly 
define objects in the room, he left his bed for the coveted stimulant. As 
his hand swept the mantel, it encountered a bottle which in his feverish 
haste he carried to his lips and instantly began to swallow its contents. 
One mouthful, however, was all he disposed of in this way, for he drank 
from a bottle of strong water of ammonia. For a few moments, suffoca- 
tion seemed imminent, but at last respiration returned. When seen some 
twenty minutes later, the mucous membrane of his lips and mouth was 
intensely swollen and reddened, his tongue so enlarged it filled the cavity. 
The patient was speechless and breathing with difficulty. By signs he 
indicated intense pain in his stomach and passage to it. This man even- 



4-2 ACCIDENTAL DISTURBANCES. 

tually recovered, and fifteen years after is still living. The passage to the 
stomach was so severely burned that when it healed it became contracted, 
and forcible dilatation by appropriate instruments has since been neces- 
sary. 

Treatment. In cases of poisoning by ammonia, vinegar and water, 
which is readily procurable, should be given freely and on the instant. 
This may be followed by copious acid drinks, lemonade, orange juice, 
etc. A o-enerous dose of sweet oil will also be useful. Ice freely em- 
ployed will control somewhat the inflammation. Opium will be needed to 
subdue pain. 

Antimony {tartar-emetic, butter of antimony). In poisoning by this 
agent, there is a metallic taste, nausea, and violent vomiting ; burning heat 
in the stomach, colic, and purging; difficulty in swallowing, thirst, cold per- 
spiration, faintness, great debility, and, should the case terminate fatally, 
death may be preceded by giddiness, insensibility, difficult respiration, and 
possibly convulsions. If vomiting and purging do not occur, the other 
symptoms are more severe. 

Treatment. If the poisonous agent is tartar-emetic, vomiting should 
be encouraged with warm water or milk, and by tickling the throat. In 
the meantime, make a strong infusion of common tea, and give it freely, 
without milk or sugar. Afterwards opiates may be administered, if their 
use is indicated. 

For butter of antimony, magnesia, chalk, whiting, or lime-water, must 
be administered in milk, together with the remedies recommended in poi- 
soning by tartar-emetic. 

Arsenic (ScheeWs green, rat-poison, fly-powder, Foider^s solution). 
The usual symptoms of arsenical poisoning, which commence within a half 
hour or an hour of swallowing the agent, are an austere taste, thirst, a 
sense of constriction and heat in the throat, inducing constant hawking, 
faintness, pain, and burning heat of the stomach, increased by pressure, 
nausea, and incessant vomiting. To these symptoms are added head- 
ache, purging of brown or bloody matter, bowels swollen and tender, 
depression of the heart's action, great restlessness and anxiety, skin at first 
hot, but later cold and clammy, breathing painful and catching, great pros- 
tration and delirium. Paralysis and convulsions generally precede death, 
which usually occurs within twenty-four hours. These symptoms are lia- 
ble to great variation, the pain and vomiting being occasionally absent, and 
the patient being affected as if by a narcotic poison. Sometimes convul- 
sions do not occur, and death then takes place calmly from collapse. 

Treatment. The first object must be to expel the poison from the 
stomach. To do this, give mustard in water, and assist its action with 
large quantities of milk and raw eggs, milk and lime-water, oil and lime- 
water, or flour and water. In the meantime send for the only true anti- 
dote, the hydrated peroxide of iron, which should be kept on hand by 



POISONS. Il';; 

druggists. This should be administered moist and in large doses, after 
vomiting is induced. Finally, a generous dose of castor-oil should be 
given. There may be needed stimulants, to cause the system to re-act from 
the great depression; ice internally, to lessen the burning; opium, to con- 
trol the pain ; to assist the action, hot applications externally will be found 
of great service. 

Belladonna {atropia, deadly night-shade). This plant grows in woods 
and gardens, and reaches about the height of three feet. The leaves, 
which are attached by short footstalks to the stem, are in pairs, of unequal 
size, oval, pointed, entirely of a dusky green on their upper surface, ami 
paler beneath. The flowers are large, bell-shaped, pendent, of a dull red- 
dish color, .with solitary peduncles rising from the axils of the leaves. The 
fruit is a roundish berry, with a longitudinal furrow on each side, at first 
green, afterwards red, ultimately deep purple, and having considerable 
resemblance to a cherry. The root, leaves, and berries are poisonous, the 
property being due to the presence of an alkaloidal principle, atropia. 

The symptoms which follow the taking of this poison are dryness and 
redness of the mucous membrane of the throat ; thirst, which nothing 
allays; dilatation of the pupils, with indistinct or double vision ; giddiness, 
palpitation of the heart, flushed face, great physical and •mental depression, 
and delirious excitement, followed by stupor. These are the chief symp- 
toms, which may set in within from half an hour to three or four hours 
after swallowing the poison. Sometimes the action of the kidneys is seri- 
ously interfered with, the quantity of urine being scanty and bloody. 
Very often a rash, like that peculiar to scarlet fever, appears on the skin. 

Treatment. Emetics, and, after they act, a generous dose of castor-oil. 
Animal charcoal should also be given freely. Opium has an action almost 
directly the reverse of belladonna, and therefore can properly be given to 
antagonize its effects. If a physician is in attendance, he will administer, if 
needed, subcutaneous injections of morphine. If medical advice cannot be 
obtained, then, if the symptoms are very urgent, forty drops of laudanum 
may be given by the friends, and repeated in an hour, if no improvement 
is noted; it should be discontinued, or the dose materially lessened, as the 
symptoms subside. 

In certain diseases of the eye, a solution of atropia is used to dilate the 
pupil. Cases are by no means rare where children have been poisoned by 
drinking this mixture, it being carelessly left within their reach. 

Bitartrate of potassium {cream of tartar). One case of poisoning by 
this agent has been reported. Death was caused by taking about an ounce 
and a half of this salt. The symptoms were those of an irritant poison, 
with paralysis of the lower extremities. Death occurred within forty-eight 
hours. 

Treatment. Vomiting must be speedily induced by emetics, or the 
stomach emptied by a stomach-pump. Mucilaginous drinks should then be 



4-4 ACCIDENTAL DISTURBANCES. 

v administered. Ice may also be given in quantity, and soothing 
applications made to the bowels will be grateful to the sufferer. 

Can * / " hemp, hashish). The extract of hemp is a 

powerful narcotic, causing exhilaration. Intoxication, delirious hallucina- 
tions, and. in its subsequent action, dizziness, drowsiness, and stupor. In 
overdoses it may produce poisonous effects. The habit of using this agent 
is not uncommon, especially among abandoned women. The treatment is 
identically the same as in cases of poisoning by opium. 

§ xmi&h flies). The fact that this agent, when given 
internally, has a peculiar excitant action upon the urinary and genital 
organs, has led to its surreptitious administration by wantonly disposed 

- 'lis. In poisonous doses, it causes a burning sensation in the throat, 
violent pain in the stomach and bowels, nausea, vomiting, purging, the 
ejections frequently bloody and purulent, great heat and irritation of the 
urinary organs, bloody urine, passed with excruciating pain; excessive 
salivation, with an exceedingly offensive breath ; hurried respiration, a hard 
and frequent pulse, burning thirst, exceeding difficulty in swallowing, some- 
times a dread of liquids; frightful convulsions, lockjaw, delirium, and 
death. 

Treatment. No antidote is known. Vomiting must be excited by 
emetics, or encouraged by warm, greasy liquids, linseed-tea, and gum-water, 
or gruel copiously administered. Opium will be needed to control pain, 
and hot baths to relax spasms. Oil must be avoided, as it is a solvent of 
the active principle (cardJtaradine) of this poison. 

Chloral hydrate. When this is taken in large quantities, it produces 
gastric irritation, nausea, vomiting, and profound stupor; the respirations 
are slow and shallow; pulse weak, rapid, and irregular; there is complete 
muscular relaxation. 

Treatment. Emetics, cathartics, and applications of mustard over the 
chest. Stimulants by mouth or injection, to maintain the heart's action 
and bodily heat. Electricity, if needed, and much the same methods as 
advised in opium-poisoning. 

Chloroform. As described by one author, the symptoms produced by 
the vapor of chloroform are divided into three groups, of varying intensity. 
First, a degree of relief from pain, the senses being slightly affected: 
second, a stage of excitement and incoherence, wherein the patient is 
prone to struggle; and, third, a stage of which the most marked features 
are complete insensibility and narcotism, with relaxation of the muscular 

em. If the use of this agent be pushed further, the breathing becomes 
noisy, the muscles quite relaxed, the pupils dilated ; while a still further 
increase of the chloroform embarrasses and then stops the breathing, and 
arrests the heart's action. The effects produced by the inhalation of ether 
are similar to those which result from chloroform. 

Treatment. The patient must be exposed to a current of fresh air, and 



POISONS, In- 

artificial respiration employed. The tongue should be pulled forward, to 
afford a free entrance and expulsion of the air. ('old effusions should be 
used, and, if possible, electricity at once applied. Brandy and ammonia 
should be injected subeutaneously. 

Colchicum (meadow saffro)i). This plant, which grows in damp mead- 
ows, was formerly the sovereign remedy in rheumatism, but is much less 
used now. When a poisonous dose has been taken, the symptoms are a 
burning sensation in the stomach, nausea, vomiting, depression of circula- 
tion, acute abdominal pain, watery discharges, suppression of urine, feeble 
pulse, cold sweats, and chilled extremities. 

Treatment. Emetics, stimulants, and artificial respiration, and every 
effort to quicken circulation, and restore bodily warmth and animation. 

Conium (common or spotted hemlock). This is a potent poison in 
large quantities, chiefly narcotic in its action, occasioning general paralysis, 
without loss of sensibility. Other symptoms associated are vertigo, res- 
piration slow and labored, and bodily temperature lowered. The treat- 
ment should be essentially the same as that advised in colchicum-poisoning; 

Copper. Poisoning by the salts of copper is a comparatively rare 
occurrence. Occasionally, however, they have been accidentally introduced 
into the system by means of food which has been cooked in a copper 
kettle. The substances of this class which are more commonly encoun- 
tered are the sulphate of copper (blue vitriol), subacetate of copper (ver- 
digris), and arsenite of copper (emerald green). 

The salts of copper, taken in very small quantities for several days, give 
rise to a metallic taste in the mouth, thirst, debility, cramps, and colicky 
pains, with symptoms of dysentery. When a poisonous dose has been 
taken, the symptoms are violent headache, pain in the stomach, gradually 
extending over the abdomen, excessive vomiting, the vomited matters 
being of a blue or green color, and diarrhoea. To these may be added 
labored breathing, great depression, chilled surface, giddiness, cramps of 
the lower extremities, slight convulsions, and, occasionally, paralysis and 
insensibility. Should death ensue, it may occur within a few hours, or not 
for several days. 

Treatment. Vomiting to be promoted by copious draughts of warm 
water. The effectual antidote is raw eggs, and several should be given, 
followed by milk or mucilaginous drinks. 

Corrosive sublimate (oxymuriate of mercury, chloride of mercury, 
bichloride of mercury). The symptoms induced by poisonous doses of this 
agent much resemble those of arsenic, only they are more immediate and 
violent. The evacuations are frequently bloody, and the abdominal pain 
is intense. The countenance becomes flushed and often swollen, although 
it is occasionally pallid and anxious. The lips and tongue become white 
and shrivelled, the breathing labored, and the pulse rapid and feeble. 
Death is preceded by cramps, insensibility, and convulsions. 



426 ACCIDENTAL DISTURBANCES. 

Treatment. Induce vomiting-, if it does not exist. It is best promoted 
by administering copious draughts of milk, into which raw eggs have been 
broken. Wheat Hour in water should also be freely given. Avoid the use 
oC a stomach-pump. Pieces of ice swallowed will be grateful to the suf- 
ferer, and opium may be needed to control the pain. 

Among other preparations of mercury which have in rare instances 
boon used as poisons are the following: calomel (subchloride or chloride of 
mercury), ammonio-chloride of mercury (white precipitate), red oxide of 
mercury (red precipitate), red sulphur et of mercury (cinnabar or vermilion), 
the cyanide of mercury, the nitrates of mercury, the turpeth mineral. 

Oroton oil. This gives rise to a burning pain in the stomach, nausea, 
vomiting, diarrhoea, with severe griping pains, frequent watery discharges, 
prostration, collapse, cold sweats, and occasionally convulsions. 

Treatment. Vomiting must be induced by emetics, unless it lias 
occurred spontaneously. After the contents of the stomach have been 
expelled, castor-oil should be given, to empty the intestine. Opium will be 
needed, and hot applications to the bowels will be useful. 

There are other vegetable irritants which, in poisonous doses, give rise 
to much the same symptoms as those ascribed to croton oil. The most 
important substances of this class are aloes, colocynth, jalap, gamboge, 
scammony, elaterium, and castor-oil seeds. 

Ergot {spurred rye, secale cornatum). The grain of wheat, barley, oats, 
or rye is apt to be attacked by a parasitic fungus, which imparts to it 
poisonous properties. Fatal epidemics in different parts of the continent 
of Europe, particularly in certain provinces of France, have long been 
ascribed to the use of bread made from rye contaminated with this fungus. 
Dry gangrene, disorders similar to typhus fever, and affections of the ner- 
vous system, attended with convulsions, are the forms of disease which 
have followed the use of this unwholesome food. Ergot has a peculiar 
influence on the muscular coat of the womb, and for this reason it is fre- 
quently used to procure abortion. The symptoms induced by a poisonous 
dose of this agent are uneasiness in the head, oppression of the stomach, 
diarrhoea, urgent thirst, burning pains in the feet, convulsive movements 
and, possibly, violent convulsions. When small quantities, frequently 
repeated, have been given, gangrene of the extremities has occurred, circu- 
lation in these parts being interfered with. 

Treatment. Alcoholic stimulants and ammonia ; hot applications to 
the surface. 

In this connection, it may be well to state that among other agents 
used as abortives are the oil of savin, oil of tansy, leaves and berries of the 
yew, and extract of cotton-viood. All these agents are irritant poisons, the 
use of which has been followed by fatal results. 

Gelsemiurn (yellow jasmine). This agent is a nervous and arterial sed- 
ative, much in use as a remedial agent. Several cases of poisoning by 



poisons. 127 

overdoses have been reported. In one instance, a college classmate of the 

writer administered by mistake a large quantity to his wife, who was 
slightly ailing, and death resulted. The symptoms are, at first, a staggering 
gait; afterwards, there is- loss of muscular power ; a numbness is diffused 

over the whole body; the eyelids close, the pupils are widely dilated, and 
do not contract to light; respirations become shallow, labored, and irreg- 
ular; the heart's action is weak, feeble, and intermittent, and death results 
from its final failure. Consciousness is preserved until near the close. 

Treatment. Emetics, alcoholic stimulants, and ammonia, heat to the 
body, electricity, and artificial respiration. Other remedies will be needed 
to restore the heart's action; only a physician can properly administer 
them. 

Iodine. This agent, in the form of compound tincture, has sometimes 
been taken internally by mistake. The symptoms which immediately fol- 
low swallowing it are intense, burning pain in the throat and stomach, 
vomiting, great thirst, headache, and fainting. 

Treatment. Emetics, if vomiting does not occur spontaneously, and it 
should be encouraged by large quantities of draughts made up of starch or 
flour in water. 

Kerosene oil. Few, doubtless, will think it possible for a person to 
take sufficient kerosene oil to produce poisonous effects. Yet poisoning by 
this agent is by no means uncommon among children, who either take it 
voluntarily and surreptitiously, or it is administered to them by careless 
mothers. It is rarely possible in these cases to learn the quantity of oil 
introduced into the stomach, and it is believed that there have been no 
fatal cases recorded. In several instances, however, extremely alarming 
symptoms have been produced by this agent. Among the symptoms noted 
are great pallor of the face, blueness of the lips, drowsiness, feeble pulse, 
coldness of the extremities, and great prostration. The pulse is usually 
irregular and intermittent, and, in severe cases, cannot be felt at the 
wrist. Sometimes children will vomit easily and quickly, and then the 
symptoms described are not pronounced; but occasionally vomiting will be 
delayed, and with difficulty excited. 

Treatment. To give mustard and water, to empty the stomach, is the 
indication, and, if vomiting does not occur at once, the finger should be 
gently passed into the throat, and there held until gagging is excited. In 
the meantime, if the lips are bluish, and the child seems very feeble, a 
tablespoonful of brandy in water should be injected. It is well to encour- 
age vomiting with warm water, until several acts occur. 

Lead. Lead in its metallic state is not injurious. It is, however, 
readily acted upon by the atmosphere, and many other influences. The 
chief compounds of lead which have been found to produce poisonous 
effects are the acetate of lead {sugar of lead), subacetate of lead (Gou- 
lard's extract), carbonate of lead (white lead, ceruse, etc.). The symptoms 



4'JS ACCIDENTAL DISTURBANCES. 

of poisoning by these preparations are obstinate constipation, violent colic, 
stiffness of the abdominal muscles, vomiting, pulse small and hard, labored 
breathing, scanty urine, and the formation of a deep blue line around the 
gums. In the severest eases, there is great prostration, tremors, paralysis 
of the extremities, and, rarely, violent convulsions. These are the effects 
usual! v observed in the cases where one poisonous dose of lead has been 
taken. In the so-called chronic lead-poisoning, the prominent symptoms are 
a blue line around the gums, and their liability to bleed from any slight 
cause, emaciation, a pallid tint of the complexion, poverty of the blood, and 
enfeebled circulation, obstinate constipation, with attacks of colic, relieved 
by pressure, diminution in the secretion of urine, and rheumatic pains.' 
Then follows weakness of the hands, wrists, and arms, ending in paralysis 
of certain muscles, or " dropped wrists," the loss of power creeping up the 
arms. The blue line mentioned is not always present, but, when noted, it 
is one of the most conclusive evidences of lead-poisoning. 

Treatment. In cases of sudden poisoning, the treatment should be the 
free administration of the sulphate of soda or magnesia, dissolved in water. 
Milk, or milk and raw eggs, will be useful. If vomiting has not occurred, 
an emetic of sulphate of zinc should be employed. Opium will be needed 
to relieve pain. 

In chronic poisoning, the sovereign remedy is the iodide of potassium, 
doses of five or ten grains, three times daily. Electricity will also mate- 
rially assist recovery, if paralysis has occurred. 

Lobelia {Indian tobacco). This plant is a native of North America, 
and its powdered leaves and seeds were formerly much in use as a remedy 
for asthma. If vomiting does not occur, the nervous system is seriously 
affected. The symptoms in such cases are great muscular weakness, trem- 
bling, slow respiration, coldness of the surface, enfeebled circulation, 
insensibility, contraction of the pupils, and sometimes convulsions. 

Treatment. Induce vomiting, if it does not occur spontaneously. 
Give freely warm, strong tea, restore vitality with friction, stimulants, and 
heat, and apply a strong mustard plaster to the chest. Opium will be 
demanded for the pain. 

Opium {morphine, laudanum, paregoric, black-drop, McMunrfs elixir, 
Dover^s powder). This drug, besides occurring in the forms mentioned, 
enters into nearly, if not quite, all proprietary medicines advertised as 
remedies for painful affections. It is the powerful ingredient of most 
soothing syrups for children, and there are but few, if any, of the so-called 
infallible cough-mixtures which do not contain opium in some form. Thus, 
preparations of the most deadly character are sold without limitation, and 
their common use by people ignorant of their essential properties has led 
to many cases of fatal poisoning. 

In considering the poisonous effects of opium, it must not be forgotten 
that some people are far more easily narcotized than others. Young chil- 



poisons. 429 

dren are particularly susceptible to its effects. A dose which one person 
might take without unpleasant symptoms being manifested, might, in 
another, prove poisonous. Again, if one is suffering from pain, it antago- 
nizes the effects of the drug, and much more can be borne than it would In- 
safe to administer in a state of perfect health. 

When a large dose of opium or any of its preparations has been taken, 
the symptoms usually manifest themselves in about twenty or thirty min- 
utes. They commence with giddiness, drowsiness, and stupor; then ensues 
insensibility. The patient appears as if in a sound sleep, from which he 
can be aroused by a loud noise, etc., although he quickly relapses. As the 
poisoning progresses, the breathing becomes less frequent and noisy, the 
face dark and suffused, then livid, and the pulse slow and full. The eyes 
are closed, while the pupils are generally contracted, often almost to the 
size of a pin's head. In some instances, the skin is cold and livid ; in 
others, it is bathed with sweat. So, also, the countenance may be either 
ghastly or pallid, and the pupils may even be dilated. At length the pulse 
becomes rapid, and so small as to be scarcely appreciable, and finally death 
occurs, occasionally preceded by convulsions. 

Tt is sometimes difficult to discriminate between opium-poisoning and 
apoplexy, fracture of the skull, etc. If the sufferer can be aroused during 
the earlier portion of the progress of these symptoms, it is more than prob- 
able that the stupor is the effect of the drug in question. The contracted 
condition of the pupil will also assist, although there are rare affections of 
the brain in which the pupils are also contracted. 

Dr. Oppenheim, in his description of the state of medicine in Turkey, 
states that persons seldom attain the age of forty who have begun the 
practice of indulgence early. The opium-eater may be known by his atten- 
uated body, withered, yellow countenance, stooping posture, and glassy, 
sunken eyes. He has no appetite, his bodily powers are destroyed, and he is 
obliged continuously to increase the dose of his "grief-assuaging remedy" 
to obtain the wished-for effect. 

Treatment. The first object is to empty the stomach, and this cannot 
be effected in any way so well as by the stomach-pump. Assuming that 
this cannot be obtained at once, then, if the victim is an adult, give as 
quickly as possible fifteen grains of sulphate of zinc in a little water. If 
drugs cannot be secured without delay, use mustard and warm water, salt 
and warm water, and tickle the top of the throat. After vomiting, give 
plenty of strong coffee, put a mustard plaster around the calf of each leg, 
and, if the patient is chilled and sinking, give freely of spirit and water. 
Keep the patient roused, and constantly in motion ; dash cold water over 
his face and shoulders, and have assistants sufficient in number to walk 
him about until the effect of the drug has passed off. Remember, if the 
unfortunate goes to sleep while the drug is yet active, it will be the sleep 
of death. Electricity will be useful, and when a physician assumes the 



4o0 ACCIDENTAL DISTURBANCES. 

care of the patient he will doubtless give belladonna by the mouth, or 

administer subcutaneous injections of atropia. If the breathing stops, 
artificial respiration should be tried. 

As has often been said, as long as life lasts the hope of recovery is not 
to be banished. The treatment must be persevered in, and in the majority 

of cases it will prove successful. 

Phosphorus. This substance is so frequently encountered, cases of poi- 
soning by it are by no means rare. It is present in the tops of matches 
most commonly used, being united with the chlorate of potash or nitre; in 
the so-called -safety matches." the phosphorus is on the box, and not on 
the match. Rat-poisons which contain this powerful irritant are numerous. 

The symptoms of poisoning by phosphorus are varied, and, if the quan- 
titv taken is small, its presence is not easily detected. At first there may 
be merely the ordinary signs of irritant poisoning. There is a hot, oniony 
taste, pain in the throat and stomach, nausea, and vomiting. The vomited 
matters are luminous in the dark; sometimes they are tinged with bile, 
and occasionally with blood. The pain in the stomach grows intense, diar- 
rhoea sets in, and the evacuations are often bloody. There is great pros- 
tration, the pulse becomes rapid and feeble, and generally delirium, paraly- 
sis, profound insensibility, and convulsions are produced. If a portion of 
the phosphorus taken into the stomach passes into the circulation un- 
changed, one of the worst forms of blood-poisoning occurs. The skin 
becomes dry, harsh, and yellow : blood is discharged from the various pas- 
sages ; it also settles under the skin, forming black spots. The urine is 
ordinarily retained or suppressed, and the little that may be passed is high- 
colored. After these symptoms are manifested, delirium and convulsions 
follow, and death occurs. 

Treatment. In treating cases of poisoning by phosphorus, the contents 
of the stomach should be thoroughly evacuated. The best emetic is the 
sulphate of copper, of which five grains should be administered, if the 
victim is an adult. Magnesia or its carbonate should be administered 
freely in milk. The common oil of turpentine can be used, but no other 
oils or fats are admissible, as they tend to dissolve the phosphorus, and 
favor its absorption. 

Strychnia {nux vomica, brticia). This agent maybe very justly termed 
a deadly poison. It is, unfortunately, the active ingredient in some prep- 
arations sold to the public for destroying such vermin as rats, and its 
careless use has led to the death of several individuals. Dr. Tanner graph- 
ically describes the symptoms in a typical case of poisoning by strychnia. 
He says : ' ; The time at which the symptoms commence varies according 
as the strychnia has been taken in solution or in a pill. In the first case. 
a very bitter taste is experienced during swallowing, usually followed in a 
few minutes by a sense of suffocation, and difficulty of breathing. Then 
there are twitchings of the muscles, jerking movements of the limbs, and a 



POISONS. l:',1 

quivering of the whole frame. The limbs become rigid, the head is bent 
back, while the body is stiffened and arched, so that it rests on the head 

and heels (opisthotonos). The difficulty of breathing causes tin- face to 
become dusky, the eyeballs prominent, and the lips livid. The features 
assume a peculiar grin {rims sardonicus) ; there is much thirst, but per- 
haps inability to drink, from spasm of the jaws; while the sufferer is quite 

conscious, is much alarmed, and is impressed with the idea that death i< 
surely stealing upon him. As the attacks of spasms are commencing, the 
patient cries out, and warns those about him of the approach of the seizure : 
he begs for help, and perhaps asks to be held, or rubbed, or turned over ; and, 
when the seizure passes off, at the end of forty or sixty second-. In- i- 
exhausted and bathed in sweat. The more he is disturbed or excited, the 
shorter is the interval between the attacks; and though a firm grasp seems 
to afford relief, yet a slight touch, a gust of air, or opening a door, will 
increase the suffering. As death approaches, the tetanic spasms rapidly 
succeed each other, and the patient sinks, suffocated during an attack, or 
exhausted during an interval, in about two hours from the beginning of 
the symptoms. 

"When the strychnia has been taken in a pill, two hours have elapsed 
before any effects have been produced. A case is also reported (Glasgow 
Medical Journal, July, 1856) where a medical man took three grains of 
strychnia dissolved in spirits of wine and diluted sulphuric acid. He went 
to bed and slept for an hour and a half, and then awoke with a spasm. 
Under treatment he recovered." 

Treatment. Vomiting should be at once induced. After this is active, 
thirty drops of laudanum may be given. The services of a physician are 
imperative, as it will be necessary for him to administer the hydrate of 
chloral by injection, and possibly etherize the sufferer. 

Tobacco. This plant possesses very poisonous properties. An infusion 
of the leaves was formerly much used as an injection in disordered states 
of the system characterized by constriction of any of its parts. The 
exceeding danger which attended its employment led to its abandonment, 
in a great degree, as a remedial agent. When taken into the stomach, the 
poison is less dangerous than a proportionate quantity introduced into the 
bowel, as it is more apt to be rejected. A celebrated French poet is said 
to have died in fourteen hours from swallowing the contents of his snuff- 
box, which had been mixed with his wine as a joke. Even the external 
application of the leaves or powder is not without danger, especially when 
the skin is broken. A case of death is on record, occurring in a child 
eight years old, in consequence of the application of the expressed juice of 
the leaves to the head for the cure of a disease of the scalp. Death has 
also been produced by the inhalation of the smoke. 

Nicotin. The essential principle of tobacco is a no less deadly poison 
than prussic acid. The symptoms of the excessive action of tobacco are 



432 ACCIDENTAL DISTURBANCES. 

severe retching, with the most distressing and continued nausea, a great 
feebleness of the pulse, coolness oi the skin, and sometimes convulsions. 

uncut. The indications are, after the evacuation of the poison, to 
support the system by external and internal stimulants, and allay irritation 
of the stomach by spirits. 

Zi •. The salts of zinc most commonly encountered are the sulphate 
of zinc {white vitriol, white copperas), the chloride of zinc, and the oxide of 
zinc. These are all irritant in their action, and when much of any one 
of these has been taken, the usual symptoms are pain in the bowels, 
violent vomiting and diarrhoea, pale and contracted features, cold extremi- 
ties, and signs of collapse. Death has occurred in less than four hours. 

Treatment. Vomiting should be encouraged with warm water, and 
carbonate of soda, magnesia, whites of eggs, or flour be given freely in 
milk. Strong tea should also be administered. 

There remain unclassified a number of substances and agencies pos- 
sessing poisonous properties. 

Poisonous fish. At certain seasons, several kinds of fish are poison- 
ous, which in other months are harmless and a wholesome food. Some, 
also, at all times act injuriously on particular constitutions. Again, tainted 
fish, in their decomposing changes, become alike poisonous to all. The 
chief symptoms are pain in the stomach, headache, flushed face, a choking 
sensation, nausea, vomiting, irritation of the eyes, depression, and often an 
eruption of the skin. 

Poisonous meats. The flesh of animals which have died of disease has 
produced serious symptoms when eaten, and has even destroyed life. 
Meats by putrefactive changes are also rendered poisonous. Cases of poi- 
soning by sausages are not uncommon, for they are generally made from 
the decomjDosing refuse of meat-shops. Bacon, ham, and other substances 
improperly preserved readily grow rancid and harmful. The symptoms 
much resemble those induced by poisonous fish. 

Poisonous mushrooms. Many fatal cases of poisoning by these fungi 
are recorded. The s}-mptoms produced are anxiety, vertigo, nausea, faint- 
ness, vomiting, and, if they are not rejected from the stomach, somnolence, 
stupor, small and intermittent pulse, distention of the abdomen, cold 
extremities, livid skin, and death in thirty-six or forty-eight hours. Some- 
times violent pains in the stomach and bowels are experienced ; occasion- 
ally, severe vomiting and purging occur, and save the patient. Blackish or 
bloody discharges from the bowels, with much straining, sometimes attend 
the action of the poison, In some instances, the symptoms are said to be 
remarkably like those induced by alcoholic drinks. The chief effects are 
not generally experienced for several hours, usually from five to ten, after 
the mushrooms have been eaten. 

Treatment. For -poisonous fish, meats, and mushrooms the remedies 



POISONS. |.;:; 

are essentially the same. Vomiting should be induced by emetics, accompa- 
nied with the free use of warm drinks, and followed, by cathartics. After 
evacuating the poison, demulcent and nutritive beverages should be given, 
and the patient's strength sustained by stimulants. Unless the sufferer 
becomes unconscious, opiates will doubtless be needed to subdue pain. 

Bites of venomous reptiles. The treatment should commence imme- 
diately the wound is inflicted. If possible, a string should he tied tightly 
about the injured part, to prevent the entrance of the poison into circula- 
tion, and the person bitten should freely and perseveringly suck the wound. 
If he cannot reach it with his lips, bystanders need not hesitate through 
fear to assist the unfortunate in his struggle for life, for these poisons may 
be smeared on the lips and tongue, or even swallowed, with impunity. 
As soon as possible, the bitten part should be cauterized. If nitrate of 
silver is within easy reach, it should be rubbed well into the very bottom 
of the wound. Strong aqua ammonia is also destructive to the poison. 
If neither of these can be secured without delay, the actual cautery should 
be applied. This need not be dreaded, as the operation is attended with 
much less pain than one would suppose. A wire, a small j^oker, or the 
steel used in sharpening knives, should be made red-hot at the point, and 
this be pressed for a moment into the wound. 

Internal treatment will be needed, and two teaspoonfuls of the aromatic 
spirit of ammonia, in one-third of a tumbler of water, should be given. 
If ammonia is not at hand, brandy or whiskey will be excellent substitutes, 
and should be taken freely. In the western states of America, the people 
there, when bitten by centipedes, tarantulas, or rattlesnakes, use tobacco 
and baking-soda as an external application, and drink whiskey to insensi- 
bility. The tobacco is hnstily chewed into a paste, the soda is thoroughly 
incorporated, and with uis mass the wound is instantly poulticed. In the 
wild regions of Texas and the Indian Territory, many miles beyond the 
residence of physicians, the writer has found hunters who maintained their 
peculiar treatment infallible. 

When bitten by any animal supposed to be mad, circulation in the limb 
should be instantly arrested, and the wound sucked and cauterized, as 
advised in the case of snake-bite. 

Irritant gases (chlorine, sulphurous acid gas, nitrous acid gas, hydro- 
chloric acid gas). These gases, in an undiluted state, are rapidly destruc- 
tive to life. The first mentioned is much employed for its bleaching prop- 
erties. The second is one of the products formed by the combustion oi 
ordinary coal. Nitrous acid gas is a very violent poison, when inhaled, 
producing inflammation of the lungs and associated symptoms. Several 
cases of death have been reported from the inhalation of this gas when 
given off by nitric acid. 

The treatment in cases of poisoning by irritant gases chiefly consists in 
the instant removal of the sufferer to pure air, artificial respiration, and 
stimulants if needed. 



434 ACCIDENTAL DISTURBANCES. 

Returning for a moment to the discussion of poisons, there are certain 
general rules to define, independent of the duties which the immediate 

treatment of the sufferer demands, and which those in attendance should 
observe. They are to remember that cases of poisoning are cither criminal, 
suicidal, or accidental, and, in a certain proportion of them, to determine 
to which of these classes they belong will not be easy. Again, it will often 
be difficult, even for a physician, to comprehend at once the exact nature 
of the poison used, as many agents give rise to common symptoms. Finally 
to be considered is the possibility of legal issues, and the detection of 
crime, if any has been committed. 

The attendants should make at least a mental note of everything which 
comes to their notice — all that they see or hear, and especially should they 
remember what is said by the patient. Each individual ought to be able 
to recall the presence of the others, the arrangement of the furniture, the 
exact location of powders and bottles, if any are in the room. Every 
symptom of the patient should be carefully noted, as an intelligent de- 
scription of them will be of the greatest assistance to the medical attendant 
when he arrives. It is also especially important that all vomited matters 
and discharges from the bowels are kept for his inspect 

In the treatment of cases of poisoning, it should be impressed upon all 
that such emergencies admit of no delay. Very often the life or death 
of the unfortunate will depend upon how the hrst few minutes are 
employed. 



APPENDIX. 



THE GERM THEORY. 

It is generally believed at the present time that the peculiar poisonous 
matters, the immediate causes of contagious and infectious diseases, are 
living germs or organism, which are introduced into the body through the 
mouth or lungs. Consonant with this theory, it is accepted that these 
germs exist in nature, are always somewhere, waiting, as it were, condi- 
tions favorable for their continued development. If this is believed, then 
it follows that for each infectious disease there is a specific germ or poison, 
which is capable of giving rise to that disease and no other. The germ 
theory has been established by facts in several cases, and it seems highly 
probable that further investigation will yet prove that it is properly 
accepted for all infectious diseases. 

The word microbe has been in general use since 1878 ; by whom it was 
devised is a matter of dispute. Microbes are defined as the most minute 
living things which can be seen through the microscope with sufficient 
distinctness to permit their organism to be studied. The word microbe is 
made use of by some observers as the general designation of all minute 
organized beings which are found on the border-land between animals and 
plants; they regard them, in fact, in the majority of cases, as true micro- 
scopic plants. 

The part which these minute organisms play in nature is an important 
one. They are found everywhere. They are nourished at the expense of 
dead organic matter, whether of animal or vegetable origin, and " in this 
way they clear the surface of the earth of all dead and useless substances 
which are the refuse of life, and thus they unite animals and plants in an 
endless chain." These minute organisms are the causes of putrefaction, 
and were it not for them all the waste and corruptible matters which every- 
where abound would be well nigh indestructible. " Life would be impos- 
sible, because the return to earth and air of all that has ceased to live would 
be suddenly suspended." 

But in addition to these useful microbes, says Trouessart, there are 
others, which are injurious to us, while they fulfil the physiological destiny 
marked out for them by nature. Such are the microbes which produce 

435 



436 APPENDIX. 

diseases in wine, most of the changes in food and industrial substances, 
and, finally, a large number of the diseases to which men and animals 
are subject. The germs of these diseases, which are only the spores or 
seeds of the microbes, float in the air we breathe and in the water we 
drink, and thus penetrate into the interior of our bodies. Hence we see 
the importance of becoming acquainted with these microbes. Their study 
concerns the agriculturist, the manufacturer, the physician, the professor 
of hygiene, and, indeed, we may say that it concerns all, whatever our pro- 
fession or social position may be. There is not a single day nor a single 
instant of our lives in which we cannot be said to come in contact with 
microbes. They are, in fact, the invisible agents of life and death. 

Dallinger and Drysdale have described the development of monads, 
certain germs, under observation. At first the normal almost oval form 
divides into two. This was accomplished in six or seven minutes. At 
this rate, says one calculator, a single form would give rise to a thousand 
like itself in the course of one hour, to about a million in two hours, and to 
a number greater than the generally assumed number of human beings now 
living in the world in three hours. Another has estimated that if each 
spore of one species only of the higher fungi germinated and reproduced 
its parent, the children w^ould in the first generation and in the course of a 
few days form a carpet all over the earth. 

Appreciating this wonderful multiplication of germs, it is not difficult 
to understand why infection is often so rapid, and epidemics so speedily 
follow the introduction of one infected person into a community in which 
his especial disease has been previously unknown. This marvellous repro- 
ductive power of germs may also explain the suddenness of attacks and 
the virulence of the symptoms of certain infectious diseases. Entering the 
blood, they multiply with such rapidity that all the vital powers are soon 
depressed, if not overwhelmed by them. 

Regarding the minuteness of germs, says a popular monthly, it is 
altogether beyond the power of the mind to conceive the minute size of 
some of the germs which, in their subsequent development, work such 
wondrous changes, and have such important influences on health and sev- 
eral industrial processes. We read of the experiments of Pasteur, Tyn- 
dall, and others, but we seldom realize the infinitely small size of the 
organisms and germs referred to, for some are undoubtedly so minute that 
the most powerful microscope fails to detect them. The minute organ- 
isms capable of inducing changes analogous to the fermentation caused by 
yeast have received great attention of late years, and several important 
diseases are distinctly traced to them. Bechamp estimated that 8,000,000,- 
000 of germs of one micro-ferment occupied only one cubic 25th of an 
inch. Not one of these minute bodies could develop except by carrying 
on complicated processes of a chemical nature, involving very active 
movements of its atoms and molecules. The mathematicians have made 



APPENDIX. 437 

calculations founded on the pressure exerted by gases, and other consider- 
ations, which show that a particle of this sort of matter, such as albumen 

and protoplasm, chiefly concerned in life processes, contains in a space <>\ 
one cubic thousandth of an inch more molecules than any one could possibly 
form any conception of. Sorby, by taking a probable mean of such calcu- 
lations, supposes one cubic thousandth of an inch of water to contain 
3,700,000,000,000,000 molecules. A sheet of ordinary note paper is about 
one-hundredth of an inch thick. One-tenth of this would, of course, 
be one-thousandth of an inch, and a little cubical box of that size each 
way would hold the amazing number of water molecules mentioned. J *erhaps 
a few thousand of such molecules may suffice for some manifestations of 
life ; but, even if many millions should be requisite for the structure of 
the simplest and humblest germ, we could never expect to see the actual 
beginnings of life. 

To the microbes which all believe the causes of infectious diseases the 
term " bacteria " is usually applied. Owing to their extreme minuteness, 
and great transparency, a study of them under the microscope is attended 
with the greatest difficulty, and as yet it is in its infancy. This class of 
diseases has been termed filth-diseases, as decomposing animal and vege- 
table matter is recognized as a hot-bed for the rapid growth and multipli- 
cation of the germs. When, also, the vitality of the human system 
becomes lowered, by the corrupt influence of filthy surroundings, it is then 
good soil for the continued development of the germs. 

It may be said that at the present day there are practically but two 
theories respecting the origin of most infectious diseases, entertained by 
the medical profession. The one by far the most popular has already 
been defined — that they are directly due to vegetable germs which "are 
always somewhere in lurk to burst forth when the conditions arise, as 
smouldering embers burst into flames." The other theory is that infec- 
tious diseases originate in impalpable poisons, produced from filth during 
some of the chemical changes which take place in its particles under cer- 
tain conditions. 

It will be seen that filth is the basis of either theory, and that most of 
this class of diseases depends largely upon bad sanitary conditions. If the 
people generally could be taught to appreciate this fact, and be induced to 
study and apply the laws of hygiene, not only would they be, in a very 
great measure, protected against epidemics, but, when communities are 
attacked, the dissemination of infection would be reduced to the narrowest 
possible limits. Not only will the result of this study and its application 
be to immeasurably reduce the number of diseases in question, but the gen- 
eral health of mankind will be markedly improved, and longer life enjoyed. 



438 APPENDIX. 



QUACKERY. 



The statement concerning quackery which Willicli once made, has 
lost little of its truth although nearly one hundred years have since passed. 
That ancient writer said : " In one respect we have little occasion to extol 
our own enlightened age, at the expense of those which are so frequently 
and justly termed dark. I allude to the bold and artful designs of impos- 
ture, and particularly medical imposture. We daily see illiterate and 
audacious empirics sport with the lives of a credulous public, that seem 
obstinately resolved to shut their ears against all suggestions of reason and 
experience." If this is not true at the present day in every State, in 
many, at least, the first successful effort to crush out that malignant evil, 
quackery, is yet to be made. 

A doctor is defined a learned man; a man skilled in a profession. A 
quack is a boaster; one who pretends to skill or knowledge which he does 
not possess. Certainly there is no mistaking these meanings, these two 
extremes are as divided as right and wrong, and yet the public generally 
is as ready to sanction the assumption of the title by an ignoramus as it 
is to recognize the claim of him upon whom it has been conferred as an 
honorary mark of distinction by University or College. One does not 
now hear the term quack applied where it is deserved quite as often as 
formerly; to a certain extent, the term "irregular" has displaced it. 
Practically they mean the same, and it is a questionable delicacy which 
prompts the educated physician to substitute the mild term " irregular" 
wdiere that of quack rightfully belongs. 

How may a man become a Doctor of Medicine within the true mean- 
ing of the term? First, he must be well educated in the English studies, 
have a competent knowledge of physics, and be able to translate easy 
Latin prose. He must also be able to pass an examination in such one of 
the following branches as he may elect ; French, German, the elements of 
Algebra or Plane Geometry, or Botany. With these qualifications a young 
man may find entrance into any Medical College or University in America, 
and if he has not had previous instruction under a physician, a three- 
year course of study is before him. He may, however, pass two years 
under the tuition of a regularly graduated physician in good standing, and 
then after one continuous year in college he will be entitled to his degree, 
providing, of course, he proves himself worthy of the honor. Before he 
can secure his diploma he must pass a creditable examination in every 
branch of his studies. At Harvard Medical College there are some thir- 
teen examinations. They are more rigid in some colleges than in others ; 
probably at Harvard the standard is fixed the highest of any in this coun- 
try, and not an aspirant can pass there who is not found in every way 



APPENDIX. 

worthy of the title he seeks. If he is deficient in a single branch, his 
diploma is withheld, and lie is forced to study until he can pass the exam- 
iner before whom he failed. Three years, then, must a man devote to deep 

and patient study, and at least one of those years must be passed in Col- 
lege under the eyes of competent instructors, who are chosen from the 
most eminent in the medical profession. If a man <1><.'S not pursue this 
course of instruction, and does not meet with all the requirements, lie lias 
no moral right whatever to the title of Doctor of Medicine, and if he 
assumes the same he is a quack, a charlatan, a mountebank, a pretender, 
and a fraud. This despicable class who have stolen the title of honest 
men can wear it openly. There is no need of concealment, at least in 
many States, where the offence, one might say, is justified by the absence 
of law or enforcement of the same if one exists. Therefore, neither 
legally nor morally are they responsible, and these harpies find rich pick- 
ings and feast and fatten on the credulity of man. 

Who, asks an old writer, would employ a blacksmith to repair a watch, 
a barber to shoe a horse, a ship-carpenter to make bonnets, or a milliner 
to build a church? Or who would send a son to a dumb man to learn 
elocution, or to one born deaf to be taught music ? And yet it is quite as 
reasonable and philosophical to do one of these things as to expect the 
human system to be repaired by one who knows nothing of it. Cure, 
says another ancient writer, is founded on the nature of the body in rela- 
tion to mind, life, and matter; and to swallow medicines without an 
understanding of what is needed, is more likely to aggravate than to alle- 
viate disorder. Practical medicine is based on practical acquaintance 
with the action of medicinal agents on natural functions; and as no func- 
tion is solitary, but all the organs of the body are associated and influenced 
one by another, so if one organ be diseased, all the body suffers with it ; 
and as any local disease, unchecked, produces death, so any medicine that 
acts on any function must more or less affect all. Tims we see that, 
strictly speaking, there can be no specific remedies, or medicines limited 
in their action to specific ailments, and he who pretends to the possession 
of such means is an impostor. And so also is he who pretends to any 
secret method of curing disease; truth and science wear no disguises, and 
court the light rather than darkness. Real professors of medicine make 
no mystery of their business, and we may confidently affirm, with the great 
Dr. Johnson, that "where secrecy or mystery is found, roguery is not 
far off." 

In the matter of reform the public generally have placed educated 
physicians in a false position. What honorable man ever saw a man per- 
petrating a fraud that he did not want to warn and so protect the victim. 
That is precisely the position in which reputable physicians are placed. 
Personally it is none of their business how badly the public are gulled. 
Really it does not affect them in but oneway; they pity the party who 



APPENDIX. 

has not sense enough to see and appreciate that he is being victimized, and 
they want to point out to him his danger. As a rule, when they under- 
take to do so, they receive no thanks for it ; but more often the one whom 
they, actuated by purely charitable promptings, have sought to assist, is 
the first to impute to them selfish motives. Physicians know that 

are in danger of being accused of jealousy, and they are, perhaps, 
also disgusted with the gullibility of the multitude. Is it. therefore, sur- 
prising that they hesitate to interfere, notwithstanding it is clearly their 
- • 

It is an old and threadbare story which the quack is wont to tell; 
.1 the regular and educated physician is jealous of him, injures his 
business, takes patients from him," etc. Xo one better than the charla- 
tan himself knows that his assertion is a mere tissue of falsehoods. As 
well muiht he say that the moon paled before the light of a candle. The 
actual fact is, quacks make business for the regular physicians, and if that 
fraudulent class were excluded from a community, the health of the peo- 
ple therein would be measurably improved ; there would be less for the 
educated physician to do. This is readily explained. It is easy to excite 
the fears of people where health is concerned ; even when perfectly well, 
they are singularly apt to imagine themselves the victims of derangement, 
if not disease. In fact, there are but few who do not have some pet 
imaginary weakness or ailment. 

From time to time communities are flooded with circulars blazed with 
wood-cuts picturing cancerous ulcers, hideous deformities, innumerable 
tape-worms, and the like. These, from their very nature, have peculiar 
attractions for many people. As they read them, they who have alw ys 
considered themselves well begin to question if they are so. As they scan 
the list of symptoms ingeniously selected and cunningly emphasized, they 
are certain to recognize one or more from which they have some time in 
their lives suffered- Thus is the seed sown ; it soon begins to vegetate, and 
fears for the health are excited. Consultations are free : even if one is 
actually well, he thinks, since it will cost him nothing to interview the 
doctor (?), he may as well visit him. Once he nibbles at the bait he is lost. 
The wonderful man whom he visits reads at a glance that his caller is 
threatened with a grave disease. Through his own and special vista he 
sees beyond the present and far into the future, when the unhappy man 
re him, who very likely has u never seen a sick day in his life," must 
succumb to the disorder, the first symptoms of which he has pretended to 
discover. There is only one w: r>e, this wonderful man, this 

doctor (?), tells him ; it is through his infallible mixture, the ingredien T - 
which are ~ u purely vegetable," and are known only to himself. Very 
likely also he will add that the regular physicians have offered him fabu- 
lous sums for his secret; he is impoverishing them by curing all their 
patients, etc. It is a pretty strong man who frees himself when on 



APPENDIX. Ill 

quack gets the halter around his neck. As a rule, he is conquered 
without a struggle. Bottle after bottle of the marvellous mixture given 
him is used, and, simple and possibly harmless although it may be, the 
system does not need it, finally revolts at the imposition, and the vic- 
tim becomes actually ill. The habit, when once acquired, grows stronger; 
very likely, the unfortunate man consults quack after quack, and sul>- 
mits to their treatment, until, finally, sick and discouraged, he seeks an 
educated physician and places himself in his care. Thus does the quack 
make business for the reputable physician, and none are so blind they 
cannot see the utter absurdity of the claim that the genuine doctor is 
jealous of the clumsy counterfeit. 

The power of imagination, upon which quacks so largely depend, is 
well illustrated by the case of a French criminal, guilty of a crime for 
which he had been condemned to die. It was in the days of France 
when malefactors of that class were sometimes submitted to physicians for 
experimental purposes. In the case in question, in the hearing of the 
subject, the means by which he was to be executed were discussed. It 
was decided upon that he be bled to death by opening the large vein in 
the arm. Preparations were then made, and, as usual, before bleeding, 
the arm was bandaged. The patient, blindfolded, was then laid on a bed, 
his arm over the edge, and beneath the bend of the elbow was placed a 
basin. A quantity of water in the meantime had been heated blood-warm. 
The vessel holding this was placed near the bed, and a tube adjusted so 
the water could be conducted to the arm about to be operated upon. 
Everything being in readiness, instead of opening the vein as the subject 
believed the physicians were about to do, they simply made a slight 
scratch, which was naturally mistaken for the entrance of the lancet. At 
the same time, a stream of the blood-warm water was allowed to fall 
without force on the arm where they had pretended to open it. This, 
trickling down into the basin, was naturally supposed by the criminal to 
be the blood flowing from the cut. He grew weaker and weaker, and 
finally died at about the same time he would had he been bled to death, 
and yet he had not lost a single drop of blood. 

In the same way, as told by a popular monthly, Mr. Loutherbourg 
cured many patients by attacking the imagination. Among those who 
visited him was a man who had long been troubled with great pains and 
swellings, particularly about the loins. On entering, Mr. Loutherbourg 
looked steadfastly at him and said: "I know your complaint. Look at 
me." They continued looking at each other some minutes ; then Mr. 
Loutherbourg asked if he did not feel some warmth in his loins, where- 
upon the man replied that he did. "Then you will feel in a few minutes 
much greater warmth." After a short pause, the man said, "I feel as if a 
person were pouring boiling water over me." Still looking in his face, 
Mr. Loutherbourg said, "How did you come here, sir?" "In a coach." 



442 APPENDIX. 

"Then go discharge your coachman and walk back to town." The coach 
was discharged, and the patient walked back to town; and the next day 
he walked five miles without fatigue. 

It the imagination is such a potent factor in curing disease, it is equally 
as powerful in causing it. More than one person well and strong has been 
drawn into the nets of quacks by their circulars and pamphlets, in which 
are strikingly portrayed the many physical evils which might be encoun- 
tered. It has been stated on reliable authority that the advertising quacks 
of this country are organized for mutual support. One man told of a 
patient whom he was trying to free from the clutches of these vultures. 
His main trouble was a mental one, a hypochondriacal depression, of which 
he was trying to rid him; but a serious drawback was his mail. Two or 
three times a week he received letters, or circulars, or pamphlets, from all 
kinds of quacks, from quack agencies, instrument makers, and patent 
medicine men; each had some new method of curing his trouble, and also 
some new way of hinting at the frightful consequences if not cured. In 
that way he was kept in a constant ferment, and came to the con- 
clusion that his name had been placed on some list accessible to all 
the quacks. 

Nothing, says the journal which told of this case, in any phase of 
human life is more painful and revolting than such unblushing efforts to 
work ivpon the misery and misfortune of mankind. Medicine, when thus 
prostituted, is truly the vilest of all trades devised by man ; for it creates 
sickness, misery, and uncleanliness in order to fatten upon it. The unfor- 
tunate feature of it nowadays is that it is being reduced to a system, has 
its organs, its institutes, and organizations for mutual benefit. 

The question is often asked, " How are we of the people to distinguish 
between irregulars and the reputable physicians." Certainly, "by their 
fruits shall ye know them"; but this is scarcely the reply which is ex- 
pected. In almost every state there are three incorporated Medical socie- 
ties, made up of three distinct classes of physicians. The largest every- 
where is composed of physicians of the so-called "regular school." 
Physicians of this class are in charge of all prominent hospitals, and 
occupy the highest positions given to physicians either by general or state 
governments. The next in size is the Homoeopathic Society, and the small- 
est of all is the Eclectic society. Now, these societies represent the only 
schools of medicine which are recognized by the general public as legiti- 
mate ; they are the only ones which have any real claims to that distinc- 
tion ; the merits of these claims are not under discussion. If a man 
practising medicine is a worthy disciple of either of these schools, he will 
certainly be a member of the state society representing his school. If he 
is not, then there is the best of reasons for questioning his integrity and 
for believing his claims fraudulent. 

A word regarding the Eclectics ; in their ranks are many worthy men 



APPENDIX. 1J.; 

socially; there are many also whom it would be well to avoid, and none 
know this better than the class first mentioned. For the better element i; 
has been a misfortune that many bogus institutions have existed and 
doubtless do exist in the United States which have called themselves 
"Eclectic," and by their fraudulent practices have heaped odium on the 
name, and not a few honest men who believe in the doctrine which they 
preach have suffered thereby. These same honest men would, without 
doubt, be the first to warn the public against those whom they consider 
interlopers in their school. 

The reader will understand that this matter just touched upon is an 
exceedingly delicate one. The member of one school of medicine is nat- 
urally prejudiced in favor of his own; the writer has, however, endeav- 
ored to be fair and impartial. He has called attention to the three classes 
of physicians who believe themselves solely entitled to be called legitimate 
and worthy the -title of Doctor in Medicine, and there the subject should 
rest ; the people must decide for themselves upon the merits of the differ- 
ent " schools." 

A noble contrast to the ostentation of the ignorant pretender is the 
modest demeanor of the educated physician. The one by every possible 
means invites public attention, the other as studiously avoids it. Every 
qualified physician, w 7 hen he commences practice, assumes an obligation to 
act honorably and openly. He has no secret remedies: all the results of 
his study and experience which promise advantage to the public health, 
he gives freely to the medical world. The quack, on the other hand, 
claims that he possesses superior means, discovered by himself, and 
known to no others. A presumed doctor doing this at once gives unmis- 
takable evidence of his fraudulent character. Such a one almost invaria- 
bly advertises in the newspapers, ancf the unqualified statement is made 
that every man who advertises himself as a physician is a quack and a 
fraud. 

A w r ord of parting advice. In the present unfortunate condition of 
things, namely, the absence of law in many states regulating the practice 
of medicine, it is the duty of all to satisfy themselves beyond all doubt as 
to the integrity and qualifications of the practitioner whom they contem- 
plate employing. They must not take it for granted, as many do, that 
every man who wears the title of doctor has a just claim to it. Rather 
let them feel, as is the truth, that more than one-half of all those who 
practise medicine at the present day are pretenders, and thoroughly in- 
competent to bear the responsibility which they assume. Another thing 
to be remembered, the mere possession of a medical diploma does not by 
any means constitute the holder a physician, or relieve him from suspicion. 
There are many fraudulent universities in America which t rathe in 
diplomas, selling them as so much merchandise. From them any man, 
no matter how ignorant, can for a small sum secure a diploma, and have 



444 APPENDIX. 

the title of doctor conferred upon him. Therefore it becomes almost 
valueless as evidence. 

When a physician enters a community, let the peojjle in it make it 
their duty, as it clearly is, to search well into his history, and if it does 
not appear that he has been properly educated in the science of medicine, 
and the diploma which lie holds has been bestowed upon him by a college 
or university of acknowledged repute, then all men should shun him as 
they would a person infected with a pestilential disease, for there is danger 
in his touch. 



TABLE OF DOSES. 



Aconite-root, tincture lto 3 drops. 

Aloes . . 2 to 5 grains. 

Aloes and myrrh, pill 1 to 3 pills. 

Aloes and myrrh, tincture i to 1 drachm. 

Ammonia, aromatic spirit ....... 15 drops to 1 drachm. 

Ammonia, elixir valerianate \ to 1 drachm. 

Ammonia, liquor acetate 2 to 4 drachms. 

Ammonia, water 5 to 15 drops. 

Ammonium, bromide 5 to 20 grains. 

Ammonium, carbonate 3 to 8 grains. 

Antimony, wine 1 to 5 drops. 

Arnica, tincture 15 to 30 drops. 

Aromatic powder . . . . . . , . 5 to 30 grains. 

Aromatic sulphuric acid 5 to 30 drops. 

Assafoetida . . . . - • . . . . 5 to 20 grains. 

Belladonna, tincture 5 to 10 drops. 

Bismuth, subnitrate 6 to 30 grains. 

Bloodroot, tincture i to 1 drachm. 

Blue-pill 1 to 10 grains. 

Borax . . . 5 to 20 grains. 

Bromide ammonium . 5 to 20 grains. 

Bromide potassium 10 to 30 grains. 

Bromide sodium 5 to 20 grains. 

Buchu, fluid extract 15 drops to 1 drachm. 

Caffeine 1 to 5 grains. 

Caffeine, citrate 1 to 5 grains. 

Calomel £ to 8 grains. 

Camphor 2 to 10 grains. 

Camphor, spirit 5 to 20 drops. 

Camphor, water \ to 2 drachms. 

Capsicum 1 to 5 grains. 

Carbolic acid . . . . . . . . 1 to 2 grains. 

Carbonate ammonium . . . , . . . 3 to 8 grains. 

Castor-oil \ to 1 ounce. 

Cayenne pepper 1 to 5 grains. 

Cerium, oxylate 1 to 3 grains. 

Chalk 8 to 20 grains. 

Chalk-mixture \ to 1 ounce. 

445 



440 TABLE OF DOSES. 

Charcoal 5 to 20 grains. 

Chloral hydrate 3 to 10 grains. 

Chloroform 1 to 5 drops. 

Cinchona, tincture 1 to 2 drachms. 

Cinnamon 10 to 20 grains. 

Cinnamon-water 1 to 2 ounces. 

Clover, red 1 to 2 drachms. 

Coca, fluid extract 1 to 2 drachms. 

Cod-liver oil 1 to 4 drachms. 

Colchicum-root, wine 8 to 30 drops. 

Colchicuin-seed, wine 5 to 20 drops. 

Colocynth, compound extract 1 to 5 grains. 

Columba, tincture 2 to 4 drachms. 

Compound cathartic pill 1 to 4 pills. 

Copaiba . 15 to 60 drops. 

Copaiba-oil . . . . ' 5 to 15 drops. 

Copper, sulphate \ to 10 grains. 

Cream of tartar 1 to 2 drachms. 

Creasote 1 to 2 drops. 

Crotcn oil \ to 1 drop. 

Cubebs 15 to 60 drops. 

Cubebs, oil 10 to 15 drops. 

Damiana 15 to 40 grains. 

Dandelion-root 1 to 2 drachms. 

Digitalis, fluid extract . . . . . . 2 to 5 drops. 

Dover's powder . 2 to 10 grains. 

Elateriuni • .. . \ to \ grain. 

Epsom salts 1 to 4 drachms. 

Ergot, fluid extract \ to 1 drachm. 

Ether, compound spirit \ to 1 drachm. 

Fowler's solution 2 to 6 drops. 

Gallic acid . . . 3 to 15 grains. 

Gelsemium, fluid extract 1 to 8 drops. 

Gentian, tincture 1 to 2 drachms. 

Ginger, fluid extract 10 to 60 drops. 

Ginger, tincture Jto 1 drachm. 

Glauber's salts 1 to 2 ounces. 

Glycerine 1 to 2 drachms. 

Grindelia robusta, fluid extract I to 1 drachm. 

Guaiacum, tincture i to 1 drachm. 

Guarana 8 to 25 grains. 

Guarana, fluid extract i to 1 drachm. 

Hoffman's anodyne i to 1 drachm. 

Hydrochloric acid, dilute . > 5 to 25 drops. 

Hyocyamus, tincture % to | drachm. 

Ipecac, emetic dose 5 to 20 grains. 

Ipecac, expectorant dose \ to 1 grain. 

Ipecac, syrup \ to 4 drachms. 

Ipecac, wine i to 1 drachm. 

Iron, dialyzed 10 to 40 drops. 

Iron, syrup of iodide 15 to 40 drops. 

Iron, tincture of chloride 5 to 30 drops. 

Jalap 8 to 25 grains. 



TABLE OF DOSES. 



447 



Kino, tincture 

Laudanum .... 

Lavender, compound tincture 
Lead, acetate 
Licorice-powder 

Lime-water 
Magnesia, carbonate 
Magnesia, liquid carbonate 
Magnesia, sulphate 
Morphine, sulphate . 
Mustard, emetic dose 
Nitre, sweet spirit 
Nux vomica, tincture 
Opium .... 

Opium, camphorated tincture 
Opium, deodorized tincture 
Opium, tincture 
Pancreatine ... 

Paregoric .... 

Peppermint, essence . 

Pepsine 

Pepsine, saccharated . 

Peruvian bark 

Pill, aloes and myrrh 

Pill, blue .... 

Pill, cathartic compound . 

Pill, rhubarb compound 

Pinkroot and senna, fluid extract 

Potassium, acetate . 

Potassium, bromide . 

Potassium, chlorate 

Potassium, iodide 

Potassium, nitrate . 

Quassia, tincture 

Quinine, sulphate . 

Rhubarb . . 

Rhubarb, aromatic syrup 

Rhubarb, compound pill . 

Rhubarb, sweet tincture 

Rhubarb, syrup . 

Rhubarb, tincture . 

Rochelle salt. 

Saffron 

Salicin .... 

Salicylic acid .... 

Salicylate of soda 

Santonin .... 

Sarsaparilla, compound syrup 

Sarsaparilla, extract 

Savin-oil .... 

Seidlitz powders 

Seneka, syrup 

Senna 



to 2 drachms. 
to "j.') drops. 
to 3 drachms. 
to 3 grains. 
to 4 drachms. 

to 2 Ounces. 

to 2 drachms. 
to 10 ounci 
to 4 drachms. 

grain. 
teaspoonful. 

to 1 drachm, 
to 20 drops, 
grain. 

to 2 drachms, 
to 25 drops, 
to 25 drops, 
to 25 grains, 
to 2 drachms, 
to I drachm, 
to 15 grains, 
to 15 grains. 
to 40 grains, 
to 3 pills. 
to 10 grains, 
to 4 pills, 
to 4 pills, 
to 2 drachms. 
to 50 grains, 
to 30 grains. 
to 20 grains, 
to 10 grains, 
to 15 grains. 
to 2 drachms, 
to 25 grains. 
to 20 grains, 
to 4 drachms, 
to 4 pills, 
to 1 ounce, 
to 4 drachms, 
to 1 ounce, 
to 1 ounce, 
to 20 grains, 
to 20 grains, 
to 10 grains, 
to 30 grains, 
to 6 grains, 
to 4 drachms, 
to 20 grains, 
to 3 chops. 
of each kind, 
to 2 drachms. 
to 2 drachms. 



448 TABLE OF DOSES. 

Soda, bicarbonate 5 to 50 grains. 

Soda, sulphate -j to 1 ounce. 

Sodium, bromide 5 to 20 grains. 

Sodium, salicylate 5 to 30 grains. 

Squill 1 to 3 grains. 

Squill, syrup i to 1 drachm. 

Sulphur, flowers \ to 2 drachms. 

Sulphuric acid, aromatic 5 to 30 drops. 

Tannic acid 2 to 10 grains. 

Tar External application. 

Tartaric acid 8 to 30 grains. 

Thoroughwort 10 to 30 grains. 

Thorouglnvort-tea 1 to 2 ounces. 

Turpentine 5 drops to \ ounce. 

Valerian, tincture 1 to 3 drachms. 

Zinc, oxide 1 to 5 grains. 

Zinc, sulphate, emetic dose 10 to 30 grains. 

Zinc, sulphate, tonic dose \ to 2 grains. 



INDEX. 



Abdominal organs, diseases of the . 295 

Accidental disturbances 405 

Acetate of lead 427 

Acetic acid, poisoning by ... . 417 

Acid of sugar, poisoning by . . . 419 

Acids, effects of on the teeth . . . Ill 

concentrated, burns by . . . 410 

poisoning by 417 

Aconite, poisoning by 420 

Adaptation of food to demand . . 69 

Aerated bread 29 

Albuminose 5 

Alcohol 47 

as a predisposing cause of dis- 
ease 53 

as preventive of disease . . 51 

beneficial effects of ... . 54 

destruction of, in the body . 48 

dietetic use of 50 

how to control the intemper- 
ate use of 55 

in bodily labor .... 49, 50 

in unusual experiences . . 52 
influence of on organs, 48, 49, 50 

moral effects of 54 

poisoning by 420 

use, under certain conditions 54 

Alexis St. Martin 3 

Algid stage 289 

Almond-drink 165 

Almonds, bitter 43 

Almonds, sweet 43 

Aloes 426 

Alopecia furfuracea 116 

Alum in bread . . * e . . . . 29 

Ambition 139 

American cheese 26 



Ammonia, poisoning by 

Anaemia 

Aneurisms 

Anger, physical effects of ... . 

Angina pectoris 

Antidotes and treatment in poisoning 

Antimony, poisoning by 

Antipathies against certain foods . . 

Aphasia 

| Aphonia 

! Apoplexy 

Apoplectic constitutions 

Apothecaries' measures 

Appearance of the body, the indica- 
tions 

Apples 

Appetite, in regulating the supply of 

food 

the loss of, in different dis- 
eases 

Approximate measures 

Aqua fortis, poisoning by ... . 

Arctics 

Arrowroot 

how to cook 

Arsenic, poisoning by 

Arsenite of copper, poisoning by . . 

Arteries, wounds of 

Artichoke 

Artificial respiration 

Asparagin 

Asparagus 

Asthma 

Atropia, poisoning by 

Aura epileptica 

Auscultation 

Autumnal fever 



421 
246 
320 
132 

243 

417 
422 
64 
173 
173 
319 
319 
191 

176 
42 

71 

174 
192 
418 
126 

37 
163 
422 
425 
405 

36 
415 

39 

39 
227 
423 
329 
197 
370 



449 






INDEX. 



Bacillus, in consumption .... 215 I 

in cholera 201 

Bacon 10 

I 93 

Baldness 116 

Banting system 255 

Barbers US 

Barley 31 

Barley-water 164 

Bathing 91 

importance of, to health . . 91 

general 94 

sea-bathing 99 

the cold bath 95 

the hot bath 97 

the toilet-bath 92 

the shower-bath 98 

the sitz-bath 98 

the vapor-bath 98 j 

the warm bath 97 

Beans 34 

nutritive value 34 

varieties of 35 

Bedclothing 89 

Bed-pan in typhoid 373 

Beds and bed-making 147 

Bed-sores 149 

Bedsteads 147 

Beef 10 

Beef-tea, action of. as usually pre- 
pared 156 

how to make it .... 162 
valuable constituents sacri- 
ficed 160 

Beer 55 

Beet-root 37 

Belladonna, poisoning by ... . 423 

Beverages 45 

Bile, action of 302 

Biliousness 297 

Birds out of season 11 

BUartrate of poiassa. poisoning by . 423 

Bite of mad dog 352. 433 

Bites of venomous reptiles .... 433 

Bitter almonds, poisoning by . . . 420 

Black vomit 361 

Bleeding, how to stop it 

Blood, drinking of 11 

Blood, impoverishment of the . . 246 

Blood of animals 11 

Bine line on gums 42S 

Blue vitriol, poisoning by ... . 425 

Boiling meat 6 



Bone, the relative amount of in ani- 
mals c . . . 10 

Bones 10 

Bread 28 

alum in 29 

changed by moisture .... 30 

composition of 29 

digestibility of 29 

toasted 30 

Bright. Dr 305 

Bright" s disease, acute 306 

chronic 309 

Brill 17 

Broken bones 412 

Bronchitis, acute ....... 220 

capillary 223 

chronic 225 

fetid 226 

Broncho-pneumonia 225 

Broths 102 

Brown-bread 33 

Brucia 430 

Buckwheat 34 

Burn of unusual severity .... 410 
Burning clothing, how to quench 

flames 410 

Burns and scalds 40J 

Burns by corrosives 410 

Butter 25 

digestibility of 2 ;' 

Cabbage, red 3S 

white 38 

Caffeine 339 

Calomel . 426 

Camp-fever 375 

Canine madness 345 

Cannabis indica, poisoning by . . . 424 

Canned goods 62 

safety of 62 

poisoning by ... . 63 

Cantharides. poisoning by ... . 424 

Cantharidine 424 

Capsules ISC 

Carbolic acid, poisoning by . . . . 417 

Carbonate of lead 427 

Cardialgia 272 

Carron oil 410 

Carrots 

Cascara sagrada 282 

Castor-oil, form least objectionable . 190 

seeds 426 

Cauliflower SS 



INDEX. 



451 



Causes of disease 17S 

co-operating or accessory . . 181 

extrinsic or external .... 178 

intrinsic or internal .... ITS 

mental or emotional .... 140 

ordinary 179 

predisposing and exciting . . 181 

primary and secondary . . . ISO 

special or specific 179 

traumatic ISO 

Caviare 20 

Celery 39 

Centipedes 433 

Cereal grains 28 

Ceruse 427 

Champoo 113 

Chaps 120 

Cheese, dietetic value of ..... . 26 

different varieties of ... . 26 

digestibility of 27 

' poisoning by 27 

Cherries 42 

Cheshire cheese 26 

Chester cheese 26 

Chicken-pox 3S1 

Chicken-tea 162 

Chills 171 

Chill and fever 355 

Chloral hydrate, poisoning by . . . 424 

Chlorine gas 433 

Chloroform, poisoning by ... . 424 

Chlorosis . 249 

Chocolate 47 

Cholera morbus 288 

epidemic 290 

sporadic ....... 288 

Chyme 5 

Cinnabar . 426 

Circulatory system, diseases of . . 238 

Clam-broth 163 

Clothing 101 

dress reform ...... 103 

general rules 106 

materials, conducting power 101 

poisonous dyes in ... . 107 

underclothing 103 

Clubbed fingers 214 

Clysters 192 

Cockles 18 

Cocoa . 47 

Cocoa-nut 43 

Cod 17 

Coffee 46 



Colchicum, poisoning by .... 425 

Cold bath 05 

Cold in the head 232 

Colic, bilious 

copper 286 

flatulent 284 

intestinal 

lead 286 

Colocynth 426 

Coma, in apoplexy 320 

in disease of the kidneys . . 308 

in epilepsy 329 

in sunstroke 323 

in typhoid fever 369 

typhus fever 376 

in yellow fever 362 

Comma-bacillus 291 

Comminuted fracture 412 

Compound fracture 412 

Conium, poisoning by 425 

Constipation 280 

Consumption 213 

its curability .... 153 

quick 2 IS 

Contagion 179 

Contusions 409 

Convulsions, teething 109 

Cooking, changes accomplished by, 5, 6, 7 

Copper, poisoning by 425 

Corn-starch 164 

Corpulence 252 

Corrosive sublimate, poisoning by . 425 

Coryza, acute 232 

Costiveness 280 

Cotton-wood, extract of 426 

Cough as a symptom 169 

Crab 18 

Crawfish 18 

Cream-cheese 26 

Cream, digestibility of 160 

Cream-of-tartar drink 165 

Cream of tartar, poisoning by . . . 423 

Crepitant rales 209 

Crepitus 412 

Croton oil, poisoning by 426 

Croupy respiration in diphtheria . . 393 

Cucumber ... 40 

Cuisine of the sick-room 1<!2 

Cyanide of potassium, poisoning by . 419 

Dandruff 114 

Darnel grass 31 

Davy, Dr., on fish as food .... 15 



45 



v> 



INDEX. 



Deadly night-shade 423 

Deafness, catarrhal 234 

in scarlet fever .... 385 

Death, from fright 135 

from great grief 137 

from snuff 431 

how it approaches .... 183 

signs of impending .... 1S3 

Decoctions 187 

Dentifrice 110 

Depilatories 119 

Despair 138 

Despondency 138 

Diabetes mellitus 313 

insipidus 317 

Diagnosis, -definition of 181 

Diarrhoea 277 

choleraic 278 

chronic 279 

nervous 278 

Diet, general remarks on .... 65 

of man 7, 8 

regulation of 13 

Dietetic preparations for the invalid 162 

regimen in diabetes . . . 315 

treatment of corpulence . . 255 

the sick . . . 152 

Digestion 2 

difficult 271 

process of 5 

Digestive system, diseases of . . . 257 

Diphtheria 391 

Dipsomania ....'..... 330 

Disease defined 152 

Diseases, number of in nomenclature, 153 

Disinfection in typhoid 372 

Dislocations 412 

of arm 414 

Doses, how to estimate 187 

table of 435 

Douche, in sunstroke 324 

Dr. Beaumont, researches of . . . 3 

Dr. Oppenheim on opium-eating . . 429 

Dr. Eoberts on dietetics 155 

Dr. Tanner on strychnine-poisoning, 430 

Dressing wounds 407 

Dress reform 105 

Dribbling of urine 176 

Drip, how constructed 415 

Dropped wrists 428 

Drops, variability of 191 

Dropsy, to what attributable . . . 177 

Drowning, treatment in 415 



Ducks 11 

Ducks, wild 12 

Duration of disease 182 

Dutch cheese 26 

Dysentery 257 

Dyspepsia 271 

Eel 16 

Eggnog 164 

Eggs 20 

composition of 20 

digestibility of 20 

quality influenced by feeding . 11 

value in feeding the sick . . . 161 

Elaterium 426 

Electricity 428 

Electuaries 187 

Emaciation, rapid 176 

Embolus 320 

Emesis, definition of 277 

Empyema 205 

Emulsin 43 

Emulsion . 187 

Endemic diseases 181 

Endocarditis 239 

Enemata 192 

Enteritis 261 

Envy 138 

Epidemic cholera 290 

diseases 181 

Epilepsia gravior 327 

mitior 327 

Epilepsy 327 

Epileptic convulsions 327 

vertigo 327 

Epistaxis . . . . ' 407 

Ergot, poisoning by 426 

Ergotism in flour 31 

Eructations 272 

Eruptive fevers 378 

Ether, poisoning by 424 

Evacuations, diagnostic importance . 175 

Evils caused by excess of food ... 70 
Exercise, amount which ought to be 

taken 80 

effects of, on the different 

organs 75 

physical 75 

results of over-exertion . . 78 

time for exercise and labor, 81 

Expectant treatment 196 

Expectoration 170 

prune-juice .... 210 



INDEX. 



453 



Face, indications of the expression . 172 

Fasting, Dr. Tanner 67 

Fear, physical effects of 134 

Febricula 354 

Feeding the sick 152 

Feet, care of the 124 

construction of the coverings 

of the 124 

deformities of the 125 

excessive sweating of the . . 126 

Felon 122 

Fever and ague 355 

Fever, autumnal 370 

intermittent 355 

malarial 355 

rheumatic 39S 

scarlet 383 

simple or ephemeral . . . 354 

typhoid 365 

typhus 375 

yellow, 361 

Fevers, continued. 365 

eruptive 378 

simple and periodical . . . 354 

Figs : . . . 41 

Fire, persons on 410 

Fish 12 

as a substitute for meat ... 13 

antipathies to 14 

desirability as food 13 

Dr. Davy on 15 

effects when preserved .... 14 

in season 17 

influences affecting the value of, 16 

poisonous 432 

poisonous effects of, on some . 14 

shell 18 

Fixed poisons 180 

Flavoring-herbs 39 

Flaxseed lemonade 165 

Flounder 17 

Fly-powder 422 

Foie gras 19 

Fomites 181 

Food 1 

adaptation of to demand . . 69 

an insufficient dietary .... 70 

antipathies ....... 64 

classifications of 8 

digestion of 2 

evils caused by excess .... 70 

importance of feeding the sick, 153 

its administration in sickness . 158 



Food, Jewish customs <> 

preservation of 7 

proper amount of 68 

th» natural diet of man ... 7 

the selection of 71 

the temperature of 72 

time for taking 72 

total deprivation of .... 07 

value of milk as a 159 

water an important constituent, 72 

Foods, accessory 45 

liquid, preparation of . . . 102 

Fowl j 1 

cooking of 12 

Fowler's solution, poisoning by . . 422 

Fracture, comminuted 412 

compound -112 

general directions . . . 413 

green-stick, or willow . . 412 

of arm above elbow . . . 414 

collar-bone 413 

forearm 414 

foreleg 414 

thigh 414 

simple 412 

time required to repair . . 414 

Fractures and dislocations . . . . 412 

French cheese 26 

Frogs . 17 

Fruits 41 

prohibited in typhoid . . . 374 

Frying food 6 

Gamboge 426 

Game 11 

Garlic 39 

Gastric juice, ingredients of . . . 4 

Geese 11 

Gelsemium. poisoning by ... . 426 

General diseases 391 

Glands, agminated 365 

solitary 365 

Goulard's extract 427 

Gout 398 

Grapes 42 

Green-sickness 249 

Grief, physiological effect of . . . 137 

Griese cheese 26 

Gruel, corn-starch 104 

Indian meal 163 

oatmeal 163 

rice-flour 104 

Gruels, fortified 161 



4-U 



INDEX. 



Dr. Robert's ren. 

on 161 

how to prepare . . 161 

- 

na 

rl 11 

drink 165 

te line on the ... IT 

Haddock IT 

Hair, care of the 112 

, preparations . . . 113 

- - - f the scalp .... 115 

- US 

tonic preparation IIS 

Hairs, inoculation of the .... 117 

IT 

Hands, care of the :_' 

Hares 12 

Haricots 34 

: aing by 421 

5D 424 

I ::: :: : : . . 133 

Hay-.- 22 

H sing the 113 

Headache, sick :; 

congestive 337 

toxic 337 

sympathetic 337 

nervous 337 

medico-legal bearing . . 338 

Health, definition of 168 

Hea::"_-:escr: 21£ 

Heart 238 

functional disorders of the. . 241 

raJar disease of the . . . 24) 

hypertrophy 241 

ation of the 241 

neuralgia of the _^ 

Heart-burn 272 

- . proper height of the .... 124 

Hemlock, common or spotted . . . i2z 

Hemoptysis _1T 

Hemorrhage, accidental 405 

from the bowels . . 17: . 

Herbaceous articles 

Herring 16 

Hominy 

Hope, physical effect ::' .... 131 

Hot bath 97 

Hulled corn 33 

.chloric acid gas 433 

poisoning ":y . . 41fi 



Hydrocyanic acid, poisoning by . . 419 

Hydrophobia 345 

Hygiene, mental 

practical 1 

oa 17 

s - 1 wounds 407 

Incontinence of urine 176 

Indian corn 32 

hemp, poisoning by ... . 424 

Indian meal gruel 163 

tobacco 428 

Infant-f ._ 24 

Infant's food. Liebig's 166 

Infectious diseases, definition of . . 179 

Influenza 221 

Infusions 181 

Ingrowing nails 121 

Inhaler, chloride of ammonium . . 23C 

Inhalations of steam 1S6 

Injections, common ingredients . . 192 

how to administer them . 193 

nourishing 194 

of opiates 193 

starch 193 

to the bowels .... 192 
Insanity, certain professions conduce 

to 130 

Insolation 322 

Insomnia 340 

Inspection 196 

Insiifficient dietary 70 

Intellectual operations 128 

Intemperance 55 

the remedy for . . . 55 

Intercurrent, as applied to disease . 181 

Invalid's dietetic preparations . . . 162 

mashed potato 166 

tea 165 

Iodine, poisoning by 42tt 

Irish ague 375 

moss 165 

Iron, how to take it 190 

Irritability of temper 133 

Irritant gases, poisoning by . . . 433 

Jalap i2f 

Jasmine, yellow 426 

Jaundice 301 

Jealousy 13S 

Jewish customs 9 

Johnny-cake 33 

Joy, physical effects of 131 



INDEX. 



\:,:> 



Kerosene oil, poisoning by . 
Kid ne y, as an article of food 

bean 

Kidneys, diseases of the. 

Kleptomania 

Knife-grinder's phthisis . 
Koch's studies in cholera 
Koumiss 

directions for male 



427 

20 

34 

305 

330 

225 

290 

22 

23 



Lacerated wounds 409 

Lamb 10 

Laudanum, poisoning by .... 428 

Lead, acetate (sugar of) 427 

carbonate (white lead, ceruse), 427 

sub-acetate (Goulard's extract), 427 

poisoning by 427 

Lead-poisoning, chronic 428 

Leguminous seeds 34 

Le haut mal 327 

Le petit mal 330 

Lemonade 165 

Lemons 42 

Lettuce 39 

Liebig's extract of meat 6 

infant's food 166 

Lime, burns by 410 

Limpets 18 

Linseed-tea 165 

Literary men, obligations of . . . 129 

Liver as an article of food .... 19 

functional derangements of . 297 

torpor of the 29S 

Liver spots 298 

Lobelia, poisoning by 428 

Lobster 18 

Love, physical effects of 131 



Mackerel 

Mad dog, bite of .... 

Maize 

Malaria 

Malt, its action in gruels .... 
Marshall Hall's directions . . . 
Mattresses for invalids' use . . . 
Meadow saffron, poisoning by . . 

Measles 

Measuring medicines 

Meats 

changes by cooking . . . 

daily quantity necessary . . 

dietetic value overestimated 

value influenced by conditions 



352, 



16 
433 

32 
357 
161 
415 
147 
425 
3S8 
191 

10 
6 

13 

71 
9 



Meat-infusions \t;\ 

Meats, poisonous 432 

Medicines and their administration . 185 

apothecaries' measures . 191 

approximate measures . . 102 
assisted or obstructed by 

mental influences . . . 188 
caution in their use de- 
manded 188 

distinctive features, but 

common effects . . . 197 
fatal mistake easy . . . 190 
fluid measures . . . . l'.tl 
general rules to avoid er- 
rors 190 

how herein prescribed . . 197 

how to estimate doses . . 187 
more active under certain 

conditions 190 

poisons in improper doses, 417 

what to keep in the house, 191 

Medicinal extracts 186 

Mental hygiene 128 

Mercury, ammonio-chloride of . . 426 

bichloride of 425 

chloride of 425 

cyanide of 426 

nitrates of 426 

oxymuriate of 425 

red oxide of 426 

red sulphuret of ... . 426 

sub-chloride or chloride of, 426 

poisoning by 425 

Miasm 179 

Migraine 336 

Milk, analysis of 21 

as an article of diet 23 

composition of the milk of va- 
rious animals 21, 22 

digestibility of 23, 159 

food-value of 159 

influenced by feeding .... 23 

koumiss 22 

peptonized 160 

preservation of 21 

the proper food of infants . . 24 

variations in 22 

Mineral acids, how taken .... 190 

poisoning by . . . 418 

green, poisoning by ... 425 

turpeth 426 

Minim 191 

Mint 39 



456 



INDEX. 



ares. 

Moral influences upon health . 
Morphine, poisoning by . . . 

Mouth, care of the 

Mulled wine 

Mumps 

Mushrooms 

poisonous .... 

Mussels 

Mutton 

tea 



Nails, care of the 

ingrowth of the 

Narcotics 

general rules in their use . 
the opium-habit easily ac- 
quired 

Nasal catarrh, acute 

chronic 

dry form of ... . 

ozsena 

Nasal douche, precautions in using . 
Nausea a common symptom . . . 
Necessity of keeping the feet warm . 

Nervous debility 

headache 

system, diseases of the . . 

vertigo 

Neufchatel cheese 

Neuralgia 

intercostal 

of the heart 

Neurasthenia 

Nicotin 

Night-sweats 

Nitric acid, poisoning by . . . . 

Nitrite of amyl 

Nitro-muriatic acid, poisoning by 
Nitro-sulphuric acid, poisoning by . 

Nitrous acid gas 

Nosebleed 

Nourishment by injections . . . . 

Nurses, duties of 

Nursing, general rules on ... . 

practical hints on ... . 

Nux vomica, poisoning by ... , 



186 

140 

42S 

108 

164 

269 

40 

432 

19 

10 

162 

120 
121 
188 
189 



190 
232 
233 
234 
234 
236 
174 
127 
325 
338 
319 
326 
26 
332 
211 
243 
325 
431 
217 
418 
244 
418 
418 
433 
407 
194 
141 
150 
141 
430 



Oatmeal 31 

gruel 163 

Oats 31 

Obesity 253 

OZdema, to what attributable . . . 177 



Oil, cotton-seed 44 

how easily taken 190 

of vitriol, poisoning by . . . 418 

olive 44 

Oleaginous seeds 43 

Onions 39 

Onychauxis 122 

Onychogryphosis 122 

Opiates, their use 189 

Opium in proprietary medicines . . 428 

poisoning by 428 

susceptibility of children to . 428 

Opisthotonos 431 

Oranges 42 

Oxalic acid, poisoning by ... . 419 

Oyster 18 

broth 163 

Ozaena 234 

Paddy-fields 33 

Pain-annihilators 334 

Palliative measures 196 

Palpation 196 

Palpitation 241 

Pandemic diseases 181 

Paralysis 321 

Paregoric, poisoning by 428 

Parmesan cheese 26 

Paronychia 122 

Parotitis 269 

Parsnips 36 

Partridge 12 

Passion, definition of 131 

Peaches 41 

Peas 35 

Percussion . 196 

Pericarditis 239 

Peritoneum 295 

Peritonitis, acute 295 

Periwinkles 18 

Perspiration, daily quantity of . . 91 

office of 171 

Peyers patches 365 

Pharyngitis 264 

Phosphorus, poisoning by ... . 430 

Phthisis 213 

Pickles . . . 40 

Pigeon 12 

Pilchard 16 

Pill, neuralgic, Brown-Sequard . . 334 

Pin-hole pupil 376 

Pin-worms, remedy for 193 

Plaice 17 



INDEX. 



457 



Pleasure, physical effects of . . . 131 

Plethora 250 

Pleura IDS 

Pleurisy, acute 108 

chronic 203 

suppurative 205 

Pleurodynia 211 

Plums 42 

Pneumonia, acute lohar 207 

Pneumonic spot 200 

Poisons 417 

general rules in treatment . 434 
Poisonous agents. Abortive agents . 426 
Acetic acid . . 417 
Aconite ... 420 
Alcohol ... 420 
Ammonia . . . 421 
Antimony . . . 422 
Arsenic. . . . 422 
Belladonna . . 423 
Bites of reptiles, 433 
Bitter almonds . 420 
Cannabis indica, 424 
Cantharides . . 424 
Carbolic acid . 417 
Chloral hydrate . 424 
Chloroform . . 424 
Colchicum . . 425 
Conium . . . 425 
Cream of tartar . 423 
Croton oil . . . 426 
Cyanide of po- 
tassium . . . 410 
Darnel grass . . 31 
Ergot . . . . 426 
Gelsemium . . 426 
General rules in 

treatment . . 434 

Iodine .... 427 

Irritant gases . 433 

Kernels of fruits, 420 

Kerosene oil . . 427 

Lobelia. ... 428 

Mineral acids . 418 

Mouldy bread . 30 
Mushrooms, false 

or poisonous . 432 

Nicotin. ... 431 

Opium .... 428 

Oxalic acid . . 419 

Phosphorus . . 430 
Preparations of 

opium . . . 428 



Poisonous agents. Prussic acid . . 419 

Salts of copper . 425 

Suits of Lead . . 427 

Salts of mercury, 425 

Saks of zinc . . 432 

Strychnia . . . 430 

Tartaric acid . . 420 

Tobacco . . . 431 

Poisonous agents in canned goods . 63 

cheese .... 'J7 

dye-stuffs. . . 107 

fish 432 

meats ..... 432 

Poisonous fish 14, 432 

meats 432 

Polyuria 317 

Pork 10 

Pork and beans 34 

Posset 164 

Potassium bitartrate 423 

cyanide 419 

Potatoes 35 

composition of 35 

cooking of 35 

sweet 36 

Poultry, game, and wild fowl ... 11 

Practice of medicine 195 

Practical hints on nursing .... 141 

Prawns 18 

Preservation of food 7 

Principles of medicine 168 

Profuse perspiration, how to check . 93 

Prognosis, definition of 182 

Proper amount of food 68 

Prussic acid, poisoning by ... . 419 

Pulmonary consumption .... 213 

acute. . . 218 

tuberculosis 213 

Pulse 168 

Punctured wounds 408 

Pupils, characteristic changes in the, 172 

Quail 12 

Quick consumption 218 

Quinsy sore throat 266 

Rabbits 12 

Rabic microbes 346 

Rabies 345 

Radishes 37 

varieties of 37 

Raisins 43 

Rat-poison 422 



458 



INDEX. 



Rattlesnakes 4,83 

Red precipitate 426 

Red spirit of nitre, poisoning by . . 418 

Reed-birds 12 

Religion, perverted 136 

Respiration 169 

ratory system, diseases of the . 19S 

Retention of urine 176 

Revenge 133 

Rheumatic fever 398 

Rheumatism 398 

acute articular .... 39S 

chronic articular . . . 402 

sub-acute 402 

Rhubarb 39 

Rice 33 

composition of 33 

cooking of 33 

Rice-water 164 

Rigors 171 

Risus sardonicus 431 

Roe 20 

Roquefort cheese 26 

Roots 35 

Rubbers 126 

Rubeola 388 

Rye , . 32 

ergotism in 32 

Safety matches, phosphorus in . . 430 

Saffron and gin pernicious .... 386 

Sago 38 

Saliva, action of 3 

Salmon 16 

Sassenage cheese 26 

Sauer-Kraut 38 

Savin, oil of 426 

Savoy cabbage 38 

Scallops 18 

Scalp, diseases of the 115 

Scammony 426 

Scarlatina 383 

Scarlet fever 383 

Scheele's green, poisoning by '. . . 422 

Scurvy, prevention of 14 

Sea-bathing 99 

Sea-foam champoo 118 

Seal 17 

Sebaceous glands 91 

Seborrhcea 114 

Secale cornatum 426 

Selection of food 71 

Self-limited, application of term . . 196 



Sewer-gas the cause of deafness . . 88 

Shame . 139 

Shark 17 

Shell-fish 18, 19 

Ship fever 375 

Shoes 124 

Shower-bath 98 

Shrimps 18 

Sick headaches 336 

Sick-room and furnishings .... 145 

cuisine of the .... 162 

general management . . 141 

sanitary precautions . . 146 

ventilation and heat . . 146 

Simpson's bath 308 

Sitzbath 98 

Skin, appearance instructive . . . 174 

Sleep 83 

advantages of early rising . . 85 

after taking food 74 

amount of, required .... 87 

night-clothing 90 

room and furnishings ... 88 

Sleeplessness 340 

Small-pox 378 

little 381 

malignant 381 

Smelling-salts, poisoning by . . . 421 

Smelt 17 

Smut of wheat 30 

Snail 19 

Snake-bite 433 

Snipe 12 

Soaps, quality of for bathing ... 94 

Sole 17 

Solutions 186 

Somersetshire cheese 26 

Sordes 368 

Sore throat 266 

diagnosis in 174 

Sounds * . . . . 20 

Spanish flies, poisoning by ... . 424 

Specific diseases 179 

Spinach 39 

Spirits 187 

Spontaneous generation 180 

Spotted fever 375 

Sprains 415 

Sprat 16 

Spurred rye, poisoning by ... . 426 

Sputa, rusty 208 

Squab 12 

Stews 6 



[NDEX. 



4S9 



Stilton cheese 26 

Stockings 125 

Stomach and intestines, diseases of 

the 271 

digestion, time required for . 4 

overtaxing of 13 

Stone-cutters' phthisis 225 

Stools, diagnostic importance of . . 175 

Strangury 170 

Strawberries 41 

Strychnia, poisoning by 430 

Study, hours profitably devoted to . 130 

Sturgeon 17 

Subacetate of lead 427 

Subsultus tendinum 368 

Suffocation, treatment in .... 415 

Suffolk cheese 26 

Sugar in the urine - 313 

Sugar of lead 427 

Sulphuric acid, poisoning by . . . 418 

Sulphurous acid gas 433 

Sunstroke 322 

Supportive measures 196 

Suppositories 194 

Suppression of urine 176 

Sweat-glands, action of 92 

Sweating of the feet 126 

Sweating of the hands .... 93, 120 

Sweetbread 20 

Sweet potato 36 

Swiss cheese 26 

Symptoms of disease 168 

diagnostic 181 

general 168 

objective 182 

pathognomonic .... 181 

prognostic 183 

subjective 181 

Table of doses 435 

Tanner's fast 67 

Tansy, oil of 426 

Tapioca 37 

Tarantulas 433 

Tarraon 39 

Tartar-emetic, poisoning by . . . 422 

Tartaric acid, poisoning by ... . 420 

Tea 45 

Teeth, care of the 109 

effects of acids on Ill 

Teething 109 

Temperance, how to insure it . . . 55 

Temperature of food 72 



Temperature of the body in health . 170 

Temperature, alterations in disease . IT') 

Terror 185 

Therapeutics, new system of . . . 153 

Thief, the East Indian test .... 132 

Thirst, present in acute affections . 171 

Toast 30 

Toast-water |t;j 

Tobacco 5fl 

action of in unusual experi- 
ences 60 

danger in external use of . 431 

death from the use of . . . 58 

effects of upon adults . . . 58 

essay on the use of ... . 58 

physiological action of . . 57 

poisoning by 431 

temperate use of .... 61 

the use of among boys . . 58 

Toe-nails, ingrowing 121 

Toilet-bath 92 

Tomato 40 

Tongue, indications afforded by the . 173 

Tonsil, abscess of the 268 

Tonsillitis, follicular 266 

simple 2G6 

Torpid liver 297 

Total deprivation of food .... 67 

Tourniquet, how to improvise . . . 406 

Tripe 20 

Troches 186 

Truffles 41 

Tubers 35 

Tubercle 213 

Tuberculosis 213 

Turbot 17 

Turkey 11 

Turnips 37 

Turpeth mineral 426 

Turtle 17 

Typhlitis 262 

Typhoid fever 365 

Typhus fever 375 

Typhus, definition of 365 

Umbilicated vesicles 379 

Underclothing 103 

Urine, its changed characteristics . 176 

Vaccination 378 

Valves of the heart 238 

Valvular disease 240 

Vapor- bath 98 



4tf0 



INDEX. 



Varicella 381 

Varicose veins 400 

Variola 37S 

Varioloid 37S 

Veal 10 

Veal-tea 102 

Venison 10 

Venom 180 

Ventilation and heat 146 

Verdigris, poisoning by 425 

Vermilion 426 

Vertigo 326 

epileptic ........ 327 

Virus ISO 

Viscera 19 

Volatile poisons 180 

Vomiting a common symptom . . . 174 

Warm bath 97 

Warts 123 

Water , . . 72 

in fevers 373 

in severe burns 410 

of ammonia, poisoning by . . 421 

Water-brash 272 



Water-cress 39 

Whale , 17 

Wheat 28 

unwholesome 31 

Whelks 18 

Whey 164 

Whitebait 17 

White copperas 432 

White lead 427 

White vitriol 432 

Whiting 17 

Whitlow .122 

Windsor bean 34 

Wine- whey 164 

Woman's province 134 

Woodcock 12 

Wounds 407 

Wrist-drop 428 

Tarn 36 

Veast 29 

Yellow jasmine 426 

Tew, leaves and berries of . . . . 426 

Zinc, poisoning by 432 



r/#£f^ 






&& 



$33 



